Patient Statement and Acknowledgments

It is important to know what to expect when coming to our offices. Please fill out the following information and click SUBMIT when finished.

 

Important: All text fields with a red label are required information.
Patient's Name:
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All new patients and some established patients (under the age of 19) will receive a complete DILATED eye exam therefore an exam generally takes about two to three hours. We strive to see patients in a timely manner but our first concern is that a thorough eye exam is performed and that all questions related to the eye problem present are answered. We apologize for any additional waiting you experience in our office.

Yes, I understand  

 

We strive to provide quality care that fits into your budget. We will determine whether your insurance will cover the cost of your visit or if you will need to pay for your visit. We do not bill for office visits or co-pay amounts. You will be expected to pay these amounts at the time of your exam.

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As a courtesy you will receive a text message reminder two days prior to your scheduled appointment. Please provide us with your current cell phone number. If you are unable to keep your appointment, it is necessary that you provide 24 hours notice.

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In order to provide optimal care to you, we expect you to make it to your appointments. A continued pattern of not showing for appointments or arriving late for appointments may result in your inability to be seen or the transfer of care from this private office to our LSU Eye Clinic.

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