CONTACT LENS MEDICAL EXAM
If you wear contact lenses or wish to try
contact lenses, your insurance plan may not cover the contact lens portion of
your exam. The Contact Lens Medical Exam (CLME) is a fee in addition to the
Comprehensive Eye Examination. The fee for a CLME can range from a level 0 at
$52.74 to Level 5 at $264.71 or higher for complex or custom lenses. The
level is determined by your doctor at the time of your exam.
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checking YES to this statement, I am indicating that I am aware of and
responsible for this charge.
We will use your email address to send
appointment reminders and other non-private correspondence. We will not share
or sell your email address.
We will send recall notices reminding
patients when they are due to schedule and
appointment via postcard and email.
With the name of your pharmacy and our
electronic prescribing software, we have the ability to access your current
prescribed medications for our records. It is important to know what
medications patients are taking for the following reasons: Many medications
may have ocular side effects, the conditions related to these medications may
have ocular manifestations, and certain prescribed medications can interact
with other medications. Indicate we have permission to access your medication
We recommend the iWellness
Exam to all of our patients. This consists of an Optomap
Scan (a digital image of the retina) and a high speed OCT scan (reveals
ocular anatomy and pathology). Together, these scans enable us to more
thoroughly evaluate you for vision threatening conditions. The iWellness Exam is only $59 and is typically not covered
by insurance. In most cases, it can be submitted to your FSA or HSA accounts.
Yes No By
checking YES to this statement, I am indicating that I am aware of and responsible
for this charge.