Patient Forms & Policies


To help get ready for your appointment, we ask that you complete the new patient forms listed below and bring them with you on the day of your exam.  Click on each one and then simply fill out and print. This will save you time when coming in for your appointment.

Patient Portal Instructions:

If you enter your information through the Patient Portal, you only need to fill out and print the forms in RED. If you do not use the Patient Portal, you need to fill out and print both RED and GREEN forms. You only need to print the Medical Records Release in BLUE if you request records from another doctor be sent to us.

Co-payments & Billing

Most insurance plans require a co-payment, which is due at the time of service. After your appointment, your insurance will be processed, and you will be billed for any services that are not covered. If you are uncertain about whether a particular service is covered, please call your insurance provider directly. If you have questions about a bill, please call the phone number listed on the billing statement.


Pupil Dilation

It may be necessary (very likely) to dilate your pupils.  This can make driving home after your visit very difficult!  It is best to bring someone with you to drive you home.  We do provide dark glasses after your visit, but it is still best to have someone drive you home.

What is a Refraction and why is it billed separately?

A refraction is the test/measurement performed by an eye doctor or technician to determine if a glasses prescription is needed or if there is any change in your eye condition. A phoropter (that thing over on the right) , fitted with various lenses, is used to perform the refraction. This is the part of the exam where the doctor or technician gives choices and asks questions such as, “which is better, one or two?” The refraction is part of a comprehensive eye exam and necessary to help the doctor determine if your vision can be corrected with glasses or if something else is causing blurred vision.  According to the federal government, the refraction is a non-covered service that must be billed separately from the exam. Because Medicare ruled the service non-covered, many other medical insurance carriers have mandated the same policy. It is also required by Medicare and therefore, required by other medical insurance carriers that the patient pays for the refraction separately from the exam.  This is mandated and we have no say-so in the matter.