THE CONTACT LENS FITTING FEE INCLUDES ALL FOLLOW-UP VISITS FOR 30 DAYS.
CONTACT LENS PRESCRIPTIONS WILL ONLY BE RELEASED AFTER THE INITIAL
FITTING PERIOD IS SUCCESSFULLY COMPLETED (WHICH MUST INCLUDE THE
EXAMINATION AND/OR FITTING AND FOLLOW-UP VISITS). AFTER 30 DAYS, IF NO
CONTACT LENS FOLLOW-UP HAS BEEN PERFORMED, OFFICE VISIT FEES WILL
BE APPLIED.
PATIENT SIGNATURE_____________________________________DATE________
PLEASE CONTACT OUR OFFICE FOR A COPY OF OUR PRIVACY POLICY.
