Patient Forms

Patient Forms

We appreciate your selection of our office for your complete eye care. The first appointment usually takes from 1 to 2 hours depending on which tests are needed.

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Most people are able to drive following dilation; but you may want to bring a driver if you have experienced problems driving after dilation in the past or if your eyes have never been dilated. You will experience difficulty with close-up work following dilation. Your vision should return within 1 to 2 hours. Parents of minor children must accompany their child to the visit and should plan to stay with their child after their visit until their vision returns.
For your first appointment, you will be asked to come early to complete some history and information forms:

  • INFORMATION SHEET
  • MEDICATION LIST
  • HISTORY QUESTIONNAIRE

By filling these forms out ahead of time, you will save significant time at the beginning of your visit. If you have any questions when filling out these forms, our staff will be happy to assist you with these questions on the day of your visit. Once you arrive at your appointment, there will be some other forms to fill out and sign as well.

At the time of your visit, please bring the completed forms if you choose to complete them in advance of your appointment, insurance cards, and picture ID. If you wear contact lenses or glasses, please bring them with you to your appointment.

Payment is due at the time services are rendered to you. We participate with many major medical insurance plans and VSP vision plan. For these plans, co-payments, deductibles, and coinsurance will be collected at the time of service. We accept cash, checks, debit cards, MasterCard, VISA, Discover, and American Express.

Many insurance plans require pre-authorization or a referral from a patient’s primary care physician before they will authorize and pay for our services. Most medical insurances do not provide coverage for a “routine” eye exam. Please check with your insurance company before your appointment to see if your plan requires pre-authorization or requires a referral and if your appointment is covered. Our staff will be happy to assist you in obtaining these authorizations.

Please familiarize yourself with our Financial Policy, Patient Rights and Responsibilities, and Notice of Privacy Practices. You will be asked to sign a statement about having received and understood these policies.

If you have special needs such as needing a translator for the deaf or a language translator, please let our staff know in advance so we can try to accommodate you during your appointment. In addition, please let our staff know if you use a wheelchair, need a wheelchair, or have other needs getting around in our office. We look forward to seeing you. Please contact us if you have any questions or we can assist you in any way.

Patient Forms

For questions call us at

Phone: (406) 252-5681

 Toll-Free: (800) 554-8158

Fax: (406) 252-5025

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