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Contact Lens And Glasses Policy
We will happily adjust a contact lens prescription at no charge as long as it falls within 90 days
after the initial contact lens fitting. If you would like your contacts adjusted outside this time due
to vision or comfort you will be recharged the initial contact lens fitting fee and the 90 day
window will reset. Contact lens prescriptions once finalized are good for 1 year. If your
irritation in contacts at a follow up is due to a medical issue it will be charged as an Office Visit.
We have a 60 day love your glasses guarantee policy. If in the first 60 days you are unhappy
with the frame or prescription, we will happily remake the lenses for you. If the prescription is
an outside prescription, we just ask that you have the original prescribing office adjust the
prescription. If you feel you have a prescription change outside 90 days but before 6 months
from the initial time the prescription was issued, we do charge a $50 refraction fee. If the change
in vision is due to other issues such as allergies, corneal irritation, or diabetes that needs to be
addressed there may be an office visit fee. If you would like a prescription update 6 months or
more after the initial prescription was given a new exam will required.
Please be aware that glasses are custom products. Once an order is placed we do not offer a
refund but we can remake the lenses once if there is an adaptation issue.
I have understood and acknowledge the Contact Lens and Glasses Policy for Westlake
Hills Vision Center
Privacy Policy
**View Patient Privacy Policy**
I Have Understand And Ancknowledge That I Have Read The Privacy Policy For Westlake Hills Vision Center.
Sharing Of Personal Information
I authorize Westlake Hills Vision Center's medical staff to
discuss my healthcare information (which may include history, diagnosis, test results, treatment
and other health information) with the people listed below. This release authorization will
remain in effect until terminated in writing by me.
My healthcare information by be released to the following people:
Name:
Relationship:
Contact Info
Name:
Relationship:
Contact Info
Do
NOT release my personal healthcare information to anyone
Privacy: We will do our best to protect the privacy of your medical information. As per Federal
Regulations, we have implemented a privacy policy and assigned a privacy officer.
An overview
of our Privacy Policy is available for you at our front desk. If you wish to see the entire
policy, please ask any staff member.
I DO I DO NOT allow you to leave a detailed message for me at my preferred method(s) of contact
Attestation
I authorize and request my insurance company to directly pay Westlake Hills Vision
Center for any health benefits resulting from care I received from Westlake Hills Vision Center. I
understand that my insurance company may not cover all services rendered on my behalf and I
agree to assume responsibility for any services or materials not covered. I consent to the release
to my insurance company of any medical records necessary to resolve claims for services
rendered. I understand that co-pays and any services not covered by my insurance company are
DUE IN FULL AT THE TIME OF SERVICE.
I understand that the insurance that I wish to use for an exam must be presented at the
time of the exam and cannot not be changed after.
I understand that failure to provide complete and accurate information may result in
denied or delayed insurance claims, an inaccurate diagnosis, or even inappropriate treatment. I
certify that the information I have given is accurate and complete.
I acknowledge that I been offered or received a copy of Westlake Hills Vision Center's
Notice of Privacy Practices. I also authorize my insurance benefits to be paid directly to my
provider, when such arrangements are made in advance. I understand that I am financially
responsible for denied claims and non-covered services and/or materials
I Have Understand And Ancknowledge That I Have Read The Attestation Policy For Westlake Hills Vision Center.
Insurance Info
Insurance
We accept VSP. VSP is a vision insurance and can be used when no other eye issues or
conditions are present. For instance, if you are near-sighted (myopia), far-sighted
(hypermetropia), have astigmatism or presbyopia (loss of near vision) and have not been
diagnosed with any other conditions or would not like any other conditions addressed the exam
would fall under vision insurance. If there is anything else that you would like discussed during
the exam such as
red eyes, dryness, allergies, or any drug prescription updates this would
fall under medical and a separate visit may be needed. It would also fall under medical if you
have been previously diagnosed with conditions such as cataracts, diabetes, glaucoma, macular
degeneration etc. and would like them addressed. We are qualified to and will happily treat any
eye conditions, however, we do not accept any medical insurances.
For those that qualify to use vision insurance, we will happily file to VSP for patients if they
have insurance but that is the only vision insurance we accept. We can provide paperwork, if
you would like so you are able to file if you do not have VSP and the visit will be at our private
pay rates.
I understand and acknowledge that I have read the Insurance Info Policy for Westlake Hills
Vision Center
Westlake Hills Vision Center Frame Waiver
We will happily adjust and maintenance a frame not purchased from Westlake Hills Vision
Center. Every effort will be made to use the utmost care while handling your frame. However,
we cannot be held liable for any damage that may occur when inserting new lenses into or
adjusting any frame that is not purchased or currently warrantied through Westlake Hills
Vision Center. Adjusting includes any service that requires frame handling such as inserting
nose pads or screws.
Although rare, if you choose to use your own frame but have new lenses inserted, should
breakage occur when lenses are being inserted at the lab, Westlake Hills Vision Center will not
be financially liable but will offer a 30% discount on any other frame a patient wishes to use for
lens insertion.
Signature:
Date(new date required
each year):
Photo Permission
I DO
or DO NOT
give Westlake Hills Vision Center Permission to use any photo taken in the office of myself in glasses on social media.
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