4155 Dr. N. Ahmad & Associates

  • The Doctors and staff are pleased to welcome you to Dr. N. Ahmad & Associates.
    Please take a few minutes to fill out this form as completely as you can.

    We look forward to working with you in maintaining your visual health.
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  • By signing below I acknowledge that:

    - The information I have provided is accurate to the best of my knowledge.
    - I am financially responsible for all charges incurred today, including contact lens fees, if applicable.
    - I may request a copy of Dr. N. Ahmad, P.C. Notice of Privacy Practices (effective April 14, 2003; Ammended September 2013), although it is posted in the office.
    - ALL EXAMINATION FEES ARE DUE UPON COMPLETION OF SERVICES.
    - Contact Lens Fitting fees ($40-$75) are due at the time of the examination. Contact lens fittings may require a follow-up visit which may be subject to additional fees if the patient fails to return within 30 days of the initial visit.
    - All rechecks on glasses or contact lenses must be done within 30 days of the original exam, or be subject to additional fees.
    - PROFESSIONAL FEES ARE NOT REFUNDABLE.