Online Patient Forms

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Eye History



Contact Lens Wearers Only


Family Eye History

Does anyone in your family have any of these eye conditions?





Medical History:

Do you have any of these medical conditions?

Family Medical History

Does anyone in your family have any of these medical conditions?

Review Of Systems

Social History

ATHENS FAMILY VISION POLICIES

ADDITIONAL TESTING & PROCEDURES

Vision insurance coverage (VSP, Davis, VCP, Avesis, Eyemed etc.) is designed to ensure the overall good health of your eyes and screenings of conditions. When a medical condition or diagnosis is determined, then medical insurance (BCBS, Aetna, Humana, Cigna, UHC, etc) is filed on the medical services required, and the co-pays for that insurance will apply. We make every effort to utilize your vision insurance, but insurance carriers set the rules and our office is required to follow them. If you have a systemic condition, have been diagnosed with an eye issue, or have complaints, your visit may require a more in-depth investigation. Further investigation may include additional medical decision-making, additional testing, follow up visits, treatment and management, or communication with your primary care physician. We will bill your MEDICAL insurance NOT your vision plan. This includes, but is not limited to the following conditions, eye issues, or problems: diabetes, hypertension, thyroid disease, lupus or autoimmune disease, diseases resulting in using high risk medications, cataracts, amblyopic/lazy eye, glaucoma/high eye pressure, macular or retinal disease, history of eye surgery, new or sudden blurry vision, flashes or floaters, dry or itchy eyes, eyestrain or double vision, eye pain or redness, headaches, loss of vision, stye.

We make every effort to be on every major carrier for your convenience and will file those claims for you. We will tell you when further testing and medical decision making is necessary. Thank you for trusting your ocular health to Athens Family Vision Clinic.

CONTACT LENS POLICY AND EVALUATION FEES

To receive a prescription for contacts, you must have a yearly contact lens evaluation. The contact lens evaluation fee is a state law and the fee is set by your vision insurance provider. This fee must be paid at the time of service.

FINANCIAL POLICY

We require all balances paid in full before ordering glasses or contacts. The patient or guardian is responsible for all charges. If an insurance payment has not been received within 60 days from the date of service, the charges will become the responsibility of the patient. Personal accounts over 90 days past due will be turned over to Carter Young Collections Services (888) 995-4242 for collection procedures.

GLASSES PRICING & WARRANTY

All frames and lenses are covered under warranty for 1 year from the date of purchase. Frame warranty replacements are for frame defects or breakages occurring from normal wear and do not include damage from animals (chew/teeth marks). If your frame has broken under warranty, please DO NOT use superglue as this will void all warranties.