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New Patient Center
To make your visit at either of our locations as smooth as possible and to save time, please download and complete the following forms and bring them with you to your upcoming visit. The forms are required to be completed initially, and then yearly,
by most insurers.
Patient Information Form (Download)
Privacy Practices Form (Download)
Financial Policy Agreement (Download)
Appointment Cancellation Policy (Download)
Download ALL Patient Forms (Packet Download)
For Dry Eye Evaluations:
What To Expect When Visiting
Initial exams typically take 60-90 minutes to complete and require drops to dilate the eyes, which may make driving difficult for 4 hours or more. Please consider having a driver or sunglasses available. Please bring your glasses and a list of current medications with you to each visit. Our doctors prefer to see patients by appointment only, unless there are emergency circumstances.
Payment is expected at the time of service. Always feel free to discuss any billing problems or concerns with our office staff or with your doctor. For patient balances and amounts due, we accept personal checks as well as VISA, MasterCard and Discover.
We “accept assignment” for persons covered by Medicare and many other major insurance carriers. This means we accept the fees determined by insurances as the full charge for each service we perform. Co-payment and deductible is determined by the patient's agreement with insurance and varies. Such co-pays and deductibles are due from the patients in such cases.
If co-payment or deductible is due, it should be paid on the day of your office visit.
If you are a patient covered by one of the several Medicaid plans, please bring your current medical card with you to each appointment. Bringing your medical card to each and every visit is required for Medicaid to cover the cost of your visit.
Fees Not Covered by Insurance
If we provide a service that your insurance does not typically cover, you will be responsible for a portion of the fee. One common example is the fee for determining your new glasses prescription—typically $30-$40. We are a member of several “vision care plans,” which may pay for glasses and glasses prescriptions. Please ask before your visit to confirm coverage if you wish to be sure. You will be responsible for the charge to determine a new glasses prescription at the time of your visit if insurance does not guarantee coverage.
If we are not a participating provider for your insurance company, we will ask for payment at the time of service and will offer you an invoice of charges that may be submitted to your insurance to seek reimbursement from them.
Marion Eye Center
1462 Marion Waldo Road
Marion, OH 43302
Delaware Eye Center
241 Paddock Court
Delaware, OH 43015
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