For Patients
Save Time, Bring Patient Forms
Registration Form
To expedite your visit, please download and fill following PDF file. Just click on the link below and print the form. Then fill out all the information that applies to you. You must have Adobe Acrobat Reader installed. Bring this form with you to your initial appointment.
Before downloading the registration form, please look over our Privacy Policy.
Medications Form
Keeping track of the medications you take, how much you take, and how often you take them is very important to all of your doctors, including your ophthalmologist. Keeping an up-to-date list of your medications is simple and easy when you have a system in place to stay organized.
Complete the medication form. You can print it and bring it with you to your first appointment.
| General Forms | Link |
|---|---|
| New Patient Registration Form | View / Download |
| HIPAA Privacy Form | View / Download |
| Current Medications Form | View / Download |
Want to Make an Appointment?
Insurance
Our doctors participate with over 150 different insurance companies. It is a good idea to contact your insurance provider to check what benefits you may have before you schedule with one of our physicians. If our physician is not listed with your insurance company, we will provide you with receipts, so that you may file with your insurance company directly.
These are the most utilized insurance companies:
- Humana
- Medicare
- Secure Horizons (Wellmed and Health Texas)
- Blue Cross
- United Healthcare
- Pacificare
- Community First
- SAEHA
- Medicaid
- Tricare
Aetna
Bring Your Insurance Card
A member of our staff will need to make a copy of your most current insurance card so please bring that with you to your appointment. It is a good idea to contact your insurance provider to check what benefits you may have when you see one of our physicians.
Referrals
Please obtain a referral from your primary care physician IF your insurance requires that you do so.
Refraction
Whether we are performing a routine eye exam or a medical eye exam we want to be sure we do a complete workup for you. A complete workup usually includes a refraction (a test for best vision). The refraction is NOT covered by most insurances. Thus, even if you are here for a medical reason, your insurance may not cover the vision test. This means that you will be responsible for the $45.00 charge for this test.
Payment
Payment is due at the time that services are rendered. Please be prepared to pay your portion of the examination charges. For your convenience our office accepts cash, checks, VISA, MasterCard, Discover and American Express.
Covered and non-covered expenses vary from plan to plan. In most cases, we will file your visit with your insurance company. We cannot guarantee that your insurance company will pay for any services rendered.
Medicare is very good health insurance. It covers almost everything in the way of care for your medical problems, but Medicare does not pay for:
- Routine eye exams
- Your annual deductible
- 20% of the cost of the visit
- The test for best vision (refraction)
- Glasses
We look forward to providing excellent eye care for you and your family.