PATIENT FORMS

We are pleased you have chosen us as your pediatric eye care specialist.  Below are the links for our new patient registration forms. 

Please read before proceeding:

What to Expect at Your Child’s First Visit to Our Office

 

During an ophthalmic exam, the doctor will evaluate your child’s visual acuity, eye movement, eye alignment, and overall health of the eye.  Your child will also be screened and evaluated for amblyopia (“lazy eye”), strabismus (misaligned or “crossed” eyes), cataracts, glaucoma, retinal abnormalities, as well as other ocular and general medical conditions which might affect eyesight.

 

We try to make the exam fun for your child.  During much of the exam, younger children will be looking at age-appropriate toys.  Games are played to obtain the cooperation of young children.  A comprehensive eye examination takes time, so plan to spend at least one and a half hours in our office.

 

For most initial eye examinations, your child’s eyes will be dilated with eye drops.  This allows the ophthalmologist or optometrist to examine vital structures of your child’s eyes including the optic nerve and retina.  Dilation will make the pupils look larger than normal.  Some children may have difficulty reading and be light sensitive for up to 24 hours, but the major effect of the drops is gone in approximately 6 to 8 hours.  On a bright day, your child may be sensitive to sunlight, so you may wish to bring sunglasses if your child has them and/or limit the time spent outside.  You may need to help your school-age child with homework and other near work as the eyesight may still be blurry for several hours.

 

What to Bring with You to Your Child’s Appointment

•  The completed registration forms.  (These can be completed online below or printed)

•  Any glasses or contact lenses that your child wears.

•  If your child has seen other eye doctors for an ongoing problem, it can be helpful to have a copy of the records.  It is usually       best for you to call and request that the records be sent to you directly.  Bring them with you the appointment.

•  Your insurance card, co-payment, and referral or authorization number (if required), if you plan on using insurance with         

   which we participate.

 

As a courtesy to our other patients, please call us to reschedule your appointment if your child has a cold, fever, chicken pox, or other contagious disease.  If you must cancel your appointment for any other reason, please give us at least 48 hours notice so that we can accommodate patients who have been waiting for their appointments.

 

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

*requires compatible .pdf viewer and a printer

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 OVER THE AGE OF SIX.  As a result, 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.)

*requires compatible .pdf viewer and a printer

@2017 by University Children's Eye Center, PC

Main Office

4 Cornwall Court

East Brunswick, NJ 08816

P: 732/613-9191

F: 732/613-1139

Bridgewater Office

678 Route 202/206 North, Bldg. 5

Bridgewater, NJ 08807

P: 908/203-9009

F: 908/203-9010