Contact Lens Policy Consent Form

COMPREHENSIVE EYE EXAM 

Evaluates the health of your eyes to rule out the possibility of any unsuspected or underlying conditions. Before the patient can be fit with contacts, a complete medical and refractive eye examination is necessary. Upon the completion of the comprehensive eye exam, qualified patients can proceed with the contact lens fitting. 

CONTACT LENS FITTING 

All patients who wear contacts must go through the fitting process yearly. The goal of the contact lens fitting is to find the most appropriate contact lens for each patient’s optimal vision and comfort. With a wide array of contacts lens types, material, sizes, curvatures, and wearing regimes, it is critical that a complete fitting and analysis occurs to ensure a proper fit. This will frequently include keratometry (corneal curvature), tear film function, and slit lamp biomicroscopy analysis of the cornea and surrounding tissue. A set of trial lenses will be dispensed at each fitting. The prescription will not be finalized until both the patient and doctor are satisfied with the fit and visual acuity of the contact lenses. A contact lens fitting must be performed within 60 days of the comprehensive eye exam. Cost varies based on insurance coverage and lens modality (toric, multifocal, monovision). Please ask the office administrator for specific charges prior to your comprehensive eye exam.  

CONTACT LENS TRAINING 

Patients who are inexperienced with contacts will be provided with personalized instructions concerning the safe care and usage of contact lenses. Upon successfully inserting and removing the lenses, the patient will leave with a set of trial lenses. A follow up appointment must be scheduled within two weeks of the visit. This training is an additional $50 to the contact lens fitting. 

CONTACT LENS FOLLOW-UP VISIT 

In order to receive your contact lens prescription it is essential and your responsibility to maintain follow up appointments and follow all lens care instructions. With each contact lens exam you will receive two follow-up visits at no additional charge within 30 days of initial visit. Additional follow-ups are subject to a charge of $25 which must be paid prior to the visit.  

PAYMENT 

Fees for the comprehensive eye exam, contact lens fitting, or annual contact lens evaluation are due at the time of service. With a valid prescription we will gladly complete a contact lens order for you over the phone. All contact lens supplies must be paid in full prior to ordering. 

EXCHANGES 

There will be no refund on professional services, opened or marked contact lens boxes. Unopened and unmarked boxes purchased within the past year may be exchanged with a new prescription or credited to your account for future use. Management approval is required for the exchange or credit.  

ACKNOWLEDGMENT 

Although our contact lens policy is effective without a signature, we kindly ask that you sign below to help our staff identify which patients need a copy of our contact lens policy for their records. We appreciate you choosing Fusion Eye Care.