Exam Registration
PATIENT INFORMATION
 
   
PRIMARY INSURER'S INFORMATION (if different from above)
 
 
Same As Above
 

Insurance Authorization
Do we accept your insurance? Most likely ...but we still have to process it. Depending on your insurance provider, this process can be time-consuming. We truly want to make your visit to our office a pleasant experience, so our staff will go to work on getting the best coverage possible that you are entitled to by your insurance carrier. Many times we find situations where your medical insurance and your vision insurance can be applied in conjunction with each other to better cover your needs .
 
 
OTHER INFORMATION - You may elaborate on any information below, and/or in the office