Family Vision Center of Porter Acknowledgement of Policies Procedures

Office Financial Policy: Co-payments and deductibles are to be paid in full at the time services are rendered. There is a $35 fee for all returned checks.*

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Appointment Policy: If you are more than 15 minutes late for your appointment, you will be asked to reschedule. Also, a $35 fee will be assessed to your account if you no-show or fail to give 24 hours notice of cancellation. A $50 fee will apply for appointments after 4pm and on Saturdays as there is high demand for these appointment times. Payment of this fee is required in order to receive any future services or products. An outstanding cancellation charge is subject to collection if left unpaid.*

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Cancellation of Glasses: In order to provide a faster return of glasses, glasses are ordered and processed over the web at the time of purchase; therefore, once these orders are placed they cannot be CANCELLED nor REFUNDED. There are also NO EXCHANGES on purchased frames.*

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Contact Lens Patients-Contact Lens Fitting: Here at Family Vision Center of Crosby, we are dedicated to providing you with the most comprehensive contact lens care possible. To ensure your long-term success with contacts, we will: -Evaluate your visual acuity with and assess the fit of your current lenses -Microscopically evaluate the health and measure the shape of the front surface of your eyes -Review the results of this evaluation and discuss available options with you *THE CONTACT LENS EVALUATION IS NOT CONSIDERED PART OF THE “COMPREHENSIVE EYE EXAM”; thus there is a separate contact lens fitting fee. Please ask us if you have any questions.*

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Insurance used on Contact Lenses: We realize that the contact lens prescriptions may take additional visits before the prescription is finalized, but due to time constraints on filing you insurance benefits for contact lenses, our office policies will be as follows: On the date of you initial fitting for contact lenses, your insurance benefits will be maxed out for the value of the contact lens benefit; this may leave a small balance on your account for the portion of a box that falls outside of your insurance benefit. We will not collect this balance until the contact lenses are ordered upon your request. This policy is in place to ensure that you do not lose any portion of your insurance benefit.*

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I understand that I am fully responsible for my account should any portion not be paid by the insurance company. By my signature, I acknowledge that I have read and understand the above statements.*

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