ADVANCED RETINAL DIAGNOSTICS(ARD)- $89 ($306 value).

We take preventative eye care very seriously. The ultra-widefield retinal imaging by Optos California and the cross-sectional optical coherence tomography by Optovue Avanti iWellness are essential for early detection of disease and prevention of vision loss. These tests are non-invasive and will not cause blurry vision. This service is NOT included with your vision plan exam, however they are included with our wellness exam at no additional fee. The ARD is an upgrade from what VSP refers to as “Retinal Imaging.”

Patient Agreements

At Ocean Park Optometry, we value your privacy and protect your health information. Please review our Notice of Privacy Policy.

By signing below:

• I acknowledge receipt of the Notice of Privacy Policy.
• I have reviewed the Fees.
• I acknowledge full financial responsibility for all charges incurred by me for services and products, regardless of insurance.  
• I understand that in order to use my benefits, I must provide all necessary information regarding my insurance prior to my services or purchases.
• I understand that my insurance company does not guarantee any payment, even with prior authorization, and that my insurance company may deny payment when the claim is processed.
• I understand that payment of the portion of the charges not covered by insurance, including deductibles, co-pays, overages, and all prior balances, is due at the time of service.
• I authorize insurance payments to be made directly to Ocean Park Optometry.
• I understand that there will be a $75 no show fee for appointments not kept without a minimum 48 hours prior notice.  For Neurovisual examinations, a $150 no show fee will apply if a 1 week prior notice is not given.
• I understand that there will be a $35 service charge on all returned checks.
• I understand that custom orders cannot be cancelled or changed after the order has been placed.
• I understand that delivery times are estimates only and cannot be guaranteed due to factors beyond our control.
• I understand that any balances unpaid after 90 days will incur finance charges.
• I agree to all reasonable attorney fees and collection costs in the event of default of payment of my charges.
• All of the information I have submitted is correct to the best of my knowledge.