Forms

To make an appointment click here or call our office at (703) 548-0122.

New Patient Information:

If you are a new patient, please download the new patient information packet, complete all of the included forms and bring them to your first appointment:

New Patient Forms

Existing Patient Information:

If you are an existing patient please download the existing information packet and complete all of the forms prior to your next appointment.

Existing Patient Forms

HIPPA Information:

– Download HIPPA forms here.

Individual Office Forms:

You can download individual office forms as needed here.

– Checklist
– Pre-Assessment Form 
– Contact Lens Evaluation Form
– Densitometer Testing Form
– HIPPA Form
– Financial Policy

Saturday Appointments Policy:

Due to the high demand for Saturday appointments, all scheduled Saturday appointments require a credit card to reserve the appointment time. Please provide 24 hours notice of cancellation. If 24 hours notice is not provided, a non-refundable $25 fee will be charged. Thank you!

If you are a new patient, please be sure to fill out all the forms provided above and bring them to our office at the time of your appointment.  We kindly request 24 cancellation notice for all appointments made.  If you are more than 15 minutes late for your appointment, please be advised you may have to be rescheduled.

Financial Policy:

Please download our financial policy here.

Insurance Facts

Fact 1 – No insurance pays 100% of all procedures.
Vision insurance is meant to assist in reducing the actual fees for eye care services.  Many of us think that insurance pays 90%-100% of all fees but in most cases only pay 50-80% of total fees. The percentage paid is determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.

Fact 2 – Benefits are not determined by our office.
Your vision benefits are based on the policy purchased by you or your employer. Insurance companies set their own schedules and each company uses a different set of fees they consider allowable. These allowable fees vary widely because each company collects fee information from claims it processes.

Fact 3 – Deductibles and co payments must be considered.
When estimating vision benefits, all deductibles, percentages and co payments must be taken in to account. All of these add to the total cost of total fees that must be paid by the patient.

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