Contact Lens Fee Explanation

Contact Lens Fee Explanation

Your total contact lens fees are determined by the complexity of your prescription and the type of lenses designed for your specific vision needs. The total fee is based on three components*:

• The examination services
• The design and follow-up services
• The contact lens materials

1. Examination Services

A comprehensive eye examination is required prior to placing any diagnostic lenses on your eyes. This evaluation is necessary to establish your baseline prescription, and to determine if the ocular structures are healthy and can support safe and comfortable lens wear.

2. Contact Lens Design & Follow-up Services

With recent advances in technology, most patients have the opportunity to wear contact lenses. The more complex the lens specifications, the more services are required to provide you with lenses that fit properly and perform well on your eyes. These services include: diagnostic assessment of lenses; lens design determination and calculations; laboratory ordering, inspection, and verification; a care and handling training visit; and finally, all required office visits.

3. Contact Lens Materials

We are committed to excellence in contact lens care. Your doctor will provide you with specific recommendations regarding the replacement schedule for your contact lenses, in addition to instructions on contact lens care. It is important to note that contact lens prescriptions expire in one year as mandated by federal law, and your doctor will need to see you again in one year to check that your eyes remain healthy for continued safe lens wear.

Your signature below serves as your acknowledgment and understanding of the customary fees for contact lens services, and your willingness to adhere to the recommended wearing schedule your doctor has prescribed.

Patient:____________________________________

Date: ______________________________________

Thank you for entrusting us with your contact lens care. We look forward to providing you excellence in contact lens service!