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We currently send appointment reminders and appointment requests using e-mails and/or text messages. We do not release this information to any third parties.
We currently send appointment reminders and appointment requests using e-mails and/or text messages. We do not release this information to any third parties. Please choose one of the following. You may change your preferences at any time.
I authorize the release of any medical or other information necessary to process this claim. I also request payment of government benefits either to myself or to the party who accepts assignment and understand I am responsible for any fee not paid by my insurance.
Family Eye History
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Patient Medical History
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Have you ever been diagnosed or treated for the following health problems?
Missed Appointment and Cancellation Policy
Due to an increased number of missed appointments and last minute cancellations Waxhaw Family Vision Care finds it necessary to change our current missed appointment policy. We understand that there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call to cancel an appointment in a timely manner, you may be preventing another patient from getting a much needed appointment. Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for a visit, due to a seeming "full" appointment book. As of February 1, 2014, the new policy will be: If an appointment is missed and has not been cancelled at least 24 hours in advance you will be charged a twenty five dollar ($25) fee; this will not be covered by your insurance company and is non-refundable. We reserve the right to dismiss patients from our practice after three missed appointments. Also, we understand that delays can happen however we must try to keep the other patients and doctors on time. If a patient arrives 15 minutes past their scheduled appointment time, it will be considered a missed appointment. The $25.00 fee will apply and we will have to reschedule the appointment.
Contact Lens Exam/Fitting Policy
If you are a contact lens wearer or would like to be fit with
contact lenses, there is a contact lens exam/ fitting fee in
addition to your regular exam fees. This runs $39.00 to
$149.00 depending on the level of care and time involved
(typically $39.00 if there are no changes). This fee will
automatically be charged to your annual exam to update your
contact lenses prescription. Your routine vision insurance may
or may not pay toward this; however, you are responsible for
this fee at the time of service. If you do not wish to update
your contact lens Rx, it is your responsibility to let us know
before your examination.
Notice of Privacy Practices (HIPPA)