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It is the policy of this office that payment of all Doctor's fees will be paid at the time of your visit. It is also the policy of this office that fees for purchase of all glasses, contact lenses, and other products are due and payable at the time of purchase. Credit on materials are issued as store credits only. Your insurance is a contract between you, your employer, and the insurance company. We are not a party of that contract. Not all services are covered in all insurance contracts. Some insurance companies arbitrarily select certain services they will not cover. We cannot render services or provide materials on the assumption that our charges will be paid by your insurance company. We cannot accept your insurance as payment unless you have a specific vision plan, for which we are providers. In that case, you will be responsible for your co-payments, and any additional charges that are not covered by your insurance company. If you would like to bill your health insurance for services rendered, we will be happy to provide you with which you may do so. If services are covered they will reimburse you directly. I understand and agree to these policies.
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© 2007 Hollywood Vision Center
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We have included a copy of our Financial Policy as an Adobe Acrobat
file since we need your signature on this document. Please print it and sign it and bring it to our office on your appointment.