Insurance & Forms
Patient Information Forms:
Please complete and bring these
2 forms with you to your appointment OR you may scan your completed forms and email it to: email@example.com
Patient Info: Click here to download file
Patient History: Click here to dowload file
Arrival Expectations: We ask that you come to our office at least 10 minutes before your apointment time to allow for registration.
If you are more than TEN minutes late, we will ask you to reschedule to the next available appointment time/date.
Records Requests: - If you need a copy of your medical records, we require 3 business days to assemble and make ready the
records for delivery. We do charge a fee to process a records request. The fee is based on the total number of pages contained
in the records.
Form Completion: In the event that a patient requires us to complete paperwork for an outside source,
and depending on the complexity and time involved, a service charge may be assessed. Short forms requiring minimal time to
complete will be assessed a $10 fee (Formshort). Complex forms requiring 15 or more minutes to complete, and which do not
require an office visit, will be assessed a $35 fee (Formlong). Some form completion work requires an office visit with your
physician. In this case, a standard office visit charge will apply.
Here is a list of our approved insurance carriers. If
you are unsure if we are contracted with your particular plan, please call your insurance company to verify.
NC Health Choice
Vision Service Plan (VSP)
EyeMed Vision Care
Blue Cross Blue Shield of NC
Community Eye Care
your insurance provider is not listed on this page, payment is due at the time the services are rendered, and you will be
responsible for filing with your insurance company.