Thank you for choosing our practice to assist you with all your vision needs. It is our mission to provide you with quality, state of the art eye care. The following is a statement of our office policies. Please read and sign this prior to the rendering of any service. 

REGARDING INSURANCE As a courtesy to our patients, our practice will make every effort to accept your insurance, but there are times that we may not be able to do so. Your insurance policy is a contract between you and your insurance company, and if services are denied you will be responsible for the balance on your account. If your insurance has not reimbursed us for your claim within 60 days, you will automatically be responsible for the balance. Any outstanding amount over 90 days will incur a 5% monthly finance charge.We require you to provide us with all and any insurance information prior to your appointment. If information is withheld, you may be responsible for full charge of exam services.

GLASSES SALES Due to the custom nature of eyeglasses, all glasses sales are final and cannot be canceled or returned. In order to get your eyewear to you in a timely manner we submit the orders right after you leave. If the order has been placed we cannot refund you. 

USUAL AND CUSTOMARY RATES Our practice is committed to providing the best treatment to our patients, and we charge fair rates based on the professional services that we provide. 

MISSED APPOINTMENTS We are a locally owned business and cannot absorb the losses associated with missed appointments. Please help us serve you better by keeping scheduled appointments. Unless cancelled at least 24 hours in advance, missed appointments will be assessed a fee of $50.00. 

PUNCTUALITY We do everything we can to be on time which means we rely on you being on time. Please try to be on time for your appointment. If you are running late, please call the office and let us know. If there is not sufficient time to complete your scheduled appointment, your appointment may be rescheduled. 

MINOR PATIENTS The adult parent/legal guardian accompanying the minor/dependent patient must be present at each visit and is responsible for payment of the minor/dependent’s account regardless of who the insurance policy holder is. For the safety of children under the age of 12, we require the supervision of an accompanying older person at all times. Our office staff cannot provide supervision for young children in the waiting area. 

I HAVE READ, UNDERSTOOD, AND AGREED TO THESE OFFICE POLICIES.