It is our true pleasure to have you here today. We strive to offer patient-centered eye and vision care. Please complete the following to help us get to know you, and tailor your exam to your exact needs.

I, the undersigned may have insurance coverage and/or vision plan coverage with an insurance carrier(s) or vision plan and assign directly to Bhend Family Eye Care PLLC dba You and Eye all medical, vision plan and/or surgical benefit, if any, otherwise payable to me for services rendered. I hereby request that Bhend Family Eye Care PLLC dba You and Eye to file any claim(s) for medical and/or preventative care benefits with my medical carrier prior to filing a claim(s) with any vision carrier or free standing vision plan unless I indicate otherwise at time of service. I hereby authorize the release of all information necessary to secure the benefit of payment of benefits As part of Dr. Bhend’s annual recall program, I authorize Bhend Family Eye Care PLLC dba You and Eye to utilize my name, mailing address, phone number, email address, and next appointment date & time to Bhend Family Eye Care PLLC dba You and Eye for the purpose of providing annual reminder postcards, coupons, and product information. I understand that: I am financially responsible for all charges whether or not paid by insurance or vision plan; co-pay, co-insurance, and deductibles are due at time of service; contact lens fitting fees, which are not generally covered by insurance not a part of a routine eye exam are due at time of service; Bhend Family Eye Care PLLC dba You and Eye charges $30.00 for any check returned from your bank; returned check fees will be added to my unpaid balance and must be paid by credit card or in cash. Contact lens fitting fees are good for 90 days from date of original contact lens fitting; any contact lens fitting not completed in 90 days may incur additional fees.

While eye exams generally include a look at the front of the eye to evaluate health and prescription changes, a thorough screening of the retina is critical to verify that your eye is healthy. This can lead to early detection of common diseases, such as glaucoma, diabetes, macular degeneration, and even cancer. The photos are quick, painless, and may not require dilation drops. More than 80% of your retina can be evaluated in one single image while traditional imaging methods typically only show 15% of your retina at one time. These photos will become a part of your medical records and will allow the doctor to compare them with subsequent photos at future exams in order to detect even the smallest amounts of change.