Please read the following patient information for your upcoming visit with Fort Worth Eye Associates. Before your appointment, please download the registration forms below, fill them out, and bring them to your appointment.
If you are unable to print out the forms before your appointment, we can provide you with forms at the office.
- Patient Registration Form
- Refraction and Consent to Treat
- Medical History 2021
- HHS form 2021
- Notification of Privacy Practices
Patient Forms – Spanish
- Registration Form-Spanish
- Refraction and Consent to Treat – Spanish
- Medical History 2021 – Spanish
- HHS form 2021 – Spanish
Patient Information for Fort Worth Eye Associates
Thank you for choosing Fort Worth Eye Associates for your eye care needs. We provide the highest standards of medical and surgical eye care by offering the most technologically advanced treatments available.
The doctors of Fort Worth Eye Associates are dedicated to providing high-quality eye care for the entire family. Patients at Fort Worth Eye Associates receive innovative and quality treatment tailored to the needs of each individual patient.
Before your appointment, please download the registration forms above, fill them out, and bring them to your appointment.
- Please bring all eye medications to every visit
- Please provide us with identification and medical insurance upon every visit
- All deductibles and co-payments are due at the time of service
- If you have insurance we will gladly process your claim, but it is your responsibility to know your benefits
Refraction Eye Exam $25
The refraction test is an eye exam that measures a person’s prescription for eyeglasses or contact lenses.
A refraction charge is $25 and is not usually covered by insurance, so this amount is charged separately and is paid directly by the patient.
Fort Worth Eye Associates participates in most major health plans.
Insurance Coverage of Routine Exam or Medical Visit
Note that when you come in for the purpose of a Healthy Eye Examination and you have no complaints, problems, or symptoms, the visit is considered routine. If during your examination you describe symptoms or medical concerns with your eyes, your provider may perform additional services to evaluate your condition. If an evaluation of a symptom, medical concern, or medical condition such as (but not limited to) cataracts, glaucoma, diabetes, macular degeneration is performed, the visit is no longer considered routine, and rather, is considered a medical visit. Some insurance plans cover routine exams, which others (such as Medicare) cover medical reasons for a visit.
Affordable Care Act Insurance
If you are on insurance through the Affordable Care Act, you must bring proof from your insurance company’s website that you have paid the current month’s premium. This proof must be presented at every visit.
Call-in Clinical Questions
Please be aware if you call our office with a clinical question, our physicians and nursing staff are in clinic during the day and may not be called away from patients to speak to you. Our receptionist will get your message to our clinical staff and they will return your call as soon as possible.
NOTE: if you have recently had surgery, please notify our receptionist of any problem you are experiencing and she will immediately notify a member of our clinical staff.
No Show Policy – $25.00
Please be aware there will be a $25.00 charge for any appointments that are missed, not canceled, or rescheduled 24 hours prior to the appointment.
We request that No Food or Drinks be brought into the waiting room
Please do not use cell phones in the waiting room
We would like to thank you for entrusting us with your healthcare. We strive in providing superior, state-of-the-art care to our patients. If you have any questions or comments please contact us at our Fort Worth office at 817-732-5593 .