Contact Lens Fitting Agreement

Contact Lens Fitting

The fitting fee includes:

The Contact Lens Fitting

Contacts lens handling and cleaning instructions
Follow up visits up to 60 days
Contact Lens Solution Starter Kit
Lens changes if necessary, though the patient is responsible for any difference in cost of the contact lenses.

The fitting fee does not include:
Contact Lenses- except for disposable lenses used for fitting purposes (cost varies depending on type of lens prescribed)
The Routine Eye Exam or Comprehensive Eye Exam
Medical visits or treatment that may be necessary whether it is related to the contacts or not
Contact lens follow-ups after 60 days. There will be a $30 charge for all subsequent visits after the 60 day global period.

Contact Lens Training Session

First time contact lens wearers will be provided with a personalized instruction and/or video concerning the safe care and usage of contact lenses. You must be able to insert, remove, clean and care for the contact lenses before leaving our office with the contact lenses. This session may take up to an hour to complete. If you have difficulty with successful insertion and removal, an additional training session will be required at no additional charge.

Summary of Policies
Charges for fitting fees are due in full at the time of the fitting, and are non refundable.
All contact lenses must be paid for in full prior to being ordered.
Follow ups and other contact-lens related services performed after the above mentioned 60 day global period are subject to a $30 fee.
Many insurance plans do not cover the full cost of contact lens fees. You will be responsible for any uncovered costs incurred by the eye exam, contact lens fitting or contact lenses.
Professional fees for the complete eye exam and fitting are non refundable.
You are responsible for scheduling and attending follow up visits in order to finalize your prescription. Your prescription will not be released and contact lenses will not be ordered for you until your prescription has been finalized by the doctor.
Contact lens prescriptions expire after one year in the state of VA. All patients are required to come in for yearly exams to ensure that your eyes are healthy and the contact lenses are still fitting well.
Contact lens prescriptions cannot be renewed without an annual exam. Contact lens exams have a separate charge and are NOT included in your annual routine eye exam.
We can provide your contact lens prescription if:
You have had a contact lens exam within the last 12 months at Morgan Vision Care
You have returned for all requested follow up exams, allowing Morgan Vision Care to finalize your prescription.
An ocular medical condition does not exist, requiring follow up care.
All financial obligations have been met.

Exchange Policy

Morgan Vision Care will be happy to exchange unopened unmarked boxes of contacts. However, we will not exchange color contacts for another color. The color desired needs to be established before ordering with trial colored lenses before purchasing. Therefore, when you receive your contact lens order, call the office to establish "Right" and "Left" lenses and mark them with a sticker instead of writing on the boxes. Keep in mind, rebate contact lens boxes might not be eligible for exchange if there are end labels missing that were submitted for rebate purposes.

I understand that my cooperation is vital to my success with contact lenses. I have been instructed in the proper methods of lens care, risk, and handling. I agree to follow Morgan Vision Care's advice for wear as indicated in my record. I will notify Morgan Vision Care immediately if any eye or vision problems occur. If I am unable to reach Morgan Vision Care, I will call the nearest eye doctor or hospital immediately. I agree to follow the advice and instructions given to me by Morgan Vision Care. I have been told the possible risks and consequences of contact lenses. I know there are feasible alternatives, including spectacles. I understand my chances of success with contacts and I will be able to ask any questions I have about Morgan Vision Care's policies prior to ordering of lenses.

Signature

Date