PATIENT FORMS

We are pleased you have chosen us as your pediatric eye care specialist.  Below are the links for our patient registration forms. If you have not yet completed them, please be sure to complete them BEFORE your visit.

Please note there are TWO different sets of registration forms: one for a MEDICAL EYE EXAM and one for a ROUTINE EYE EXAM

 

You will only download/complete ONE set of forms as discussed when your appointment was booked. If you are unsure which set to download, please contact our office.

If you are booked for a

MEDICAL appointment

As outlined when your appointment was booked, a medical eye exam differs from a routine eye exam as it requires a higher level of complexity and decision-making skills from your eye care professional.  As a result, it is billed to your major medical insurance and is subject to any co-payments, coinsurance, and deductibles you may have on your policy.  It is NOT billed as a routine "vision" exam and therefore does NOT fall under any vision benefit you may have.  **Please note our pediatric ophthalmologists will ALWAYS bill a medical exam and NEVER a routine eye exam**

If you are booked for a

ROUTINE eye exam

A routine eye exam is an exam that is performed to evaluate vision and overall eye health in a child. 

It is billed as a ROUTINE "VISION" EXAM and is only covered by your insurance carrier if you have ROUTINE VISION COVERAGE on your major medical policy. 

 

**UCEC does NOT participate with any separate, standalone vision care plans (e.g., Davis Vision, VSP, MetLife, etc.)