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Insurance Claims

In order for us to direct bill your insurance company, we need your signed consent.  Please complete one of the insurance forms if you have not previously signed it, or if your insurance information has changed.  Please note:  This is for your primary insurance.  In most cases, your insurance company requires you to submit to your primary plan first, then submit the remaining amount to your secondary plan for reimbursement, if applicable.  As well, not all insurance companies and/or plans allow for direct billing.  We must act in accordance with the policies set out by your insurance company.

Forms

Be Prepared Before Your Appointment

New Patients

All new patients will be asked to fill out an intake form prior to their first appointment at our office.  Paper copies are available at our office, which you can fill out when you present for your examination, or you can fill out and submit an electronic copy ahead of time.  Anyone who is 18 years of age (or older) should fill out the Adult form.  Anyone who is under 18 (aged 0-17) should have the Child form completed.

 

Please note:  Any patients who have turned 18 since their last appointment at our office will be required to fill out the Adult form (even if they have previously filled out the Child form), and patients who have not been seen for an appointment in over 5 years will be asked to update their information using the appropriate form, as well.

Contact Lenses

Both adults and children should fill out the Contact Lenses intake form if they currently wear contact lenses.  (This is in addition to either the Adult or Child intake form.)  You do not need to fill out the Contact Lenses form if you have discontinued contact lens wear.

Vision Therapy

All new vision therapy patients will be asked to fill out an intake form prior to their assessment at our office.  Paper copies are available at our office, which you can fill out when you present for your examination, or you can fill out and submit an electronic copy ahead of time. 

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