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  • Patient Annual Consent Form

  • Welcome to Huntley Eye Care, L.L.C.! Thank you for choosing our office to provide you with your comprehensive eye examination and all your eye care needs.

    To protect your privacy and in respect for others, please DO NOT USE your cellular device while in our office.

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  • Please list the names of any individuals that you give us permission to discuss any and all vision and medical information with, as well as any information pertaining to your account.

  • AGREEMENT TO RECEIVE TEXT MESSAGING AND EMAIL COMMUNICATIONS

    Our office utilizes electronic notification system (email, text messaging) to notify our patients of appointment reminders, glasses and contact lenses pick up, office closures, scheduling conflict, etc. This is the most effective and efficient way to notify our patients. 

    By providing us with your cell phone number, you are giving us permission to communicate with you through text messaging. There is some level of risk that third parties might be able to read unencrypted text messages and it is your responsiblity to provide Huntley Eye Care, L.L.C.with any updates to your cell phone number. Text messaging rates may apply.

  • If patient is a minor, guarantor (person who will be financially responsible for account) will default to parent/legal guardian accompanying patient on day of exam.

  • iWELLNESS SCREENING

    It is highly recommended, especially during COVID-19, for the patient to complete our iWellness screening. This screening serves a tremendous role in assisting the doctor with a more thorough assessment of the patient's ocular health and in detecting any subtle changes in the eye. The screening will capture a digital retinal image of the patients eyes and allow for a scan of the retinal tissues below what is normally visible to the eye, which helps detect early signs of glaucoma, macular degeneration, diabetes in the eye, etc. The procedure is safe and harmless to the eyes and there is only a copayment of $44 for this procedure.

  • DILATION

    The dilation will enlarge the pupils of the eyes so the doctor can view structures in the back of the eye. The side effects are blurred near vision and light sensitivity for a 3-4 hours. In some patients, distance vision and driving may also be affected. Patient will need to remain in the office for additional 30-45 minutes for the dilation to be completed. Due to COVID, please also keep in mind, during this procedure you will be within 6 feet of the doctor for an extended period of time.

  • CORNEAL AND CONTACT LENS EVAULATION

    Contact lenses are FDA-regulated medical devices. A corneal and contact lens evaluation is necessary to monitor changes to the health of your eyes from utilizing these devices. There is an increased risk of infection and/or corneal ulcers that can lead to loss of vision with contact lens wear. Therefore, an annual evaluation is necessary if you would like to continue wearing, replacing, and/or reordering your contact lenses. The evaluation includes the initial evaluation, the use of diagnostic lenses, and any contact lens prescription–related follow-up visits within 60 days. Any office visits greater than 60 days or any office visits within 60 days that is not contact lens prescription-related (i.e. red eye) will be charged a separate office visit fee.

    At this time, due to COVID-19, we will not be doing any insertion and removal training; therefore, will not be able to perform a corneal and contact lens evaluation on any new contact lens wearer.

  • COVID-19 SCREENING

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  • On the day of your exam, please remember:

    • Face Mask is REQUIRED for entry.
    • Please come ALONE to your appointment.
    • Minor patients should be accompanied by ONE parent only , no other family members or siblings allowed.
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