Patient Insurance Information

  • Patient Information

  • Date Format: MM slash DD slash YYYY
  • Insurance Information

  • Date Format: MM slash DD slash YYYY
  • Please present insurance cards and form at time of service.

    I authorize the release of any medical or other information to process my insurance claims.

    I also authorize the payment of medical benefits to my doctor. It is my understanding that I am responsible to obtain any and all referrals that my insurance company requires for service performed by that doctor. I also understand that I am responsible for any changes not covered by my insurance.
  • Date Format: MM slash DD slash YYYY

Beginning Monday, May 11th, we will be returning to normal business hours and will be seeing patients for all types of vision exams. We are following all COVID-19 guidelines, including sanitizing, wearing face masks and practicing social distancing.