TENNESSEE VISION THERAPY

The following information will help prepare you for the upcoming appointment at our office. Your timely completion of the attached documents will allow us the needed time to process and review your case in advance. We ask that every page be filled out in its entirety and all pertinent medical records including your last eye exam are returned to our office at least two business days prior to your scheduled evaluation.

What is a Developmental Vision Evaluation?
A Developmental Vision Evaluation includes checking the general health of the eye, visual acuity (20/20), refractive condition for appropriate corrective lenses when needed and all of the visual functions required for reading, writing, learning, sports performance and functioning in life. A developmental vision evaluation helps to pinpoint the precise area(s) of concern as well as the depth of the problem and to determine the best treatment options.

What tests are performed?
Sensorimotor Testing- measures ocular motility, ocular alignment, and ocular deviation in more than one area of gaze and binocular fusion. It is necessary for detection, assessment, monitoring and guidance for the medical, surgical and optical management of binocular function and motor eye misalignment.

Visual Perceptual Testing- tests the brain’s ability to make sense of what the eyes see. It is important for everyday activities such as dressing, eating, writing, and working. When you have a visual processing dysfunction, more cognitive effort is needed for everyday activities.

How long does testing take?
Testing takes approximately 2 hours and is scheduled in the morning before the eyes and brain are tired from a full day of school or work. We like to do testing at this time so you have eaten a good, high protein meal and are most attentive.

Who can come to the appointment?
Because full attention is needed, it is very important that you do not bring any additional family members other than your spouse to the evaluation. We ask that only the patient or patient and spouse attend. This minimizes distraction and enhances the productivity of the time spent in our office.

What is my financial policy?
Third parties, such as medical insurance, Medicare and TennCare, severely limit treatment, care options, and the time the Doctor and team can spend with you. Therefore, The Center for Vision Development and Performance Vision Therapy is a fee-for-service facility and payment is due in full at the time of service. The total cost of the Initial Visit is $275, which includes the evaluation, testing, consultation, and a follow-up summary of the Doctor’s findings.

Will I get the results the same day?
Yes! During your consultation all of the findings will be explained to you and literature will be provided. The recommendations from the Doctor, how to proceed and expectations will also be explained.

Tennessee Vision Therapy Group
3252 Aspen Grove Drive, Suite 7
P: 615-791-5766 or 615-905-4668
info@tnvisiontherapy.com 

I hereby give my permission to Tennessee Vision Therapy to treat:

Release of information:

It is often beneficial for us to discuss examination results and to exchange information with other professionals involved in your care, with your permission. Please sign below to authorize this exchange of information.

I agree to permit information from, or copies of, my examination records to be forwarded to myself or other health care providers upon their written request or upon recommendation of Tennessee Vision Therapy when it is necessary for the treatment of my visual condition. I authorize Tennessee Vision Therapy, and/or their staff to exchange information with other professionals involved in my care by means of my signature below. This authorization shall be considered valid throughout the duration of treatment.