Forms

We are pleased to welcome new patients to our practice!

Patient Disclosure and Emergency Contact Form

Optomap Retinal Consen

HIPAA Consent Form 

Patient Health History

Insurance Information

We accept many eye insurance plans, including VSP. If we don’t take your insurance, we’ll help you file for reimbursement. Eye care services and products also qualify for your flexible spending account. There are so many plans available, please give us a call to discuss yours.

Practice Policies

Thank you for choosing Eyecare Center of Leesburg for your eye care. We strive to provide the best services and quality care possible. We also strive to have the same level of quality when billing for our services. This guide will serve to assist in getting your services paid.