PATIENT FORMS

Please fill out the following patient information forms and bring them with you to your first visit. Signing “Acknowledgment of Receipt of Privacy Practices” on the form signifies that you have read the Privacy Policy, listed below.

WHAT TO BRING TO YOUR APPOINTMENT

Please bring the following items to your appointment:

  • Your current eyeglasses or contact lenses
  • Any medications, supplements, or eyedrops you use
  • Your family health history
  • Any health conditions or allergies
  • Any health care cards or insurance information
  • Your family doctor’s name and information
  • Any questions you have about your eye health

INSURANCE PROVIDERS

AARP

Aetna Mailhandlers,NAP

Aetna Medicare

Allegiance Benefit Plan Management

Bankers Life & Casualty - Secondary Plan

Blue Cross Blue Shield

Anthem

  • Florida Blue
  • BlueCare HMO - With Referral
  • Blue Cross Blue Shield Select
  • Federal Employee Program

CHAMPVA

Cigna

  • PPO
  • Open Access Plus
  • HMO - with referral

Cigna Allegiance

Cigna Medicare Supplement

GEHA

Great American Life Insurance Co.

Health First

Health Partners

Humana - Out of Network

Manhattan Life Insurance Co. - Secondary Plan

Medicare Part B

Mutual of Omaha Insurance Company - Secondary Plan

National Elevator Industry Health Benefit

Principal Life Insurance Company

Railroad Medicare Part B

Selman & Company - Secondary Insurance State Farm Health Insurance - Secondary Plan Tricare for Life -Secondary Plan

Tricare Prime - with referral (Tricare East)

Tricare Select (Tricare East)

UMR

United American Insurance- Secondary Plan

United Health Care

  • GE Health Benefits
  • Health Select
  • Medicare Complete Choice
  • The Empire Plan
  • Travelers Choice Plus Plan
  • Choice Plus
  • Community Plan
  • AARP
  • UMR

USAA Life Insurance Co. - Secondary Plan

WellMed Medical Management, Inc.

Workers Compensation

Aetna

• Meritain

Blue Cross Blue Shield HMO Premier

Care Plus

Cigna Local Plus

Florida Health Care Plans

Freedom Health

Oscar Health

Simply Healthcare

Stay Well

Sunshine Health

United Health Care All Savers

United Health Care Dual Complete

US Health - Falls under UMR

Well Care

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