New Patient Paperwork

“For your initial visit, please download, print and fill out the patient registration and medical history forms. Give the filled out forms to the front desk staff upon arrival.  Also, please read over the office policies below.


HIPAA_Form.pdf

patientregistration.pdf

medicalhistory.pdf


Thank you for choosing Virginia Adult and Pediatric Ophthalmology. We are committed to providing you with the best eye care possible. In order to accomplish this, we need your assistance in understanding our practice policies.

Office Hours

Office hours are Monday, Tuesday, Thursday and Friday from 8:15 AM – 4:30 PM and Wednesday from 8:30 AM - 12:00 PM. The office is closed everyday from 12:15 PM to 1:15 PM for lunch.  

Appointments

Please call (571) 210-5535 to schedule an appointment.

We ask that you arrive about 15 minutes prior to your appointment time so that your chart can be prepared for the doctor.

Eye Exams

When you schedule an eye exam, you will need to bring your glasses and contact lenses if you wear them. For all contact lens wearers, please inform the staff when making the appointment over the phone that you wear contacts. If you want to renew an existing contact prescription, make sure to wear the lenses into the appointment and bring either the expired written prescription (from your previous eye doctor) or the contact lens boxes. There is a separate charge for evaluating and updating a contact lens prescription, and that price is $40.00.

The doctor may dilate your eyes during the exam; if so, your vision may be blurry and sensitive to light for a few hours. You may want to have someone take you home after the appointment.

Please allow 60-90 minutes for an initial comprehensive eye exam.

New Patients

If you are new to Virginia Adult and Pediatric Ophthalmology, please print out and complete the forms listed above, and bring with you to your appointment.

Cancellations and Late Arrivals

If you are more than 20 minutes late to your scheduled appointment, we will make every effort to work you back into the physician’s schedule. However, sometimes we may have no choice but to reschedule your appointment. We thank you for your understanding.

Please consider the traffic issues associated with traveling in northern Virginia. We ask that you arrive about 15 minutes prior to your appointment time to be fair to both our other patients and the physician.

If you will not be able to keep your scheduled appointment, then please give us a 24-hour advance notice so that we may offer the time to another patient. We understand that on occasion you may have unexpected events which prevent you from making your appointment. In any case, we may have to assess a cancelled appointment fee, based on the circumstances.

Responsibility for the Bill

All patients receiving services from Virginia Adult and Pediatric Ophthalmology are financially responsible for the timely payment of all charges incurred. For those patients with insurances accepted by our physicians, Virginia Adult and Pediatric Ophthalmology will submit the bill to such insurance companies first for payment. It is your responsibility to pay any deductible amount, co-insurance, or any other balance not paid by your insurance.

Insurance Cards

Please bring your insurance card(s) with you, especially if you are a patient new to the practice. Failure to bring your insurance card(s) may result in a rescheduled appointment if we are unable to verify coverage, unless you are willing to pay for the visit out of pocket.

Referrals

If your insurance plan requires a referral in order for you to see a specialist, it is your responsibility to have your primary care physician submit the referral prior to your visit. If we have not received your referral by the time of your appointment, we will allow you an additional 20 minutes to obtain one and work you back into the physician’s schedule. We will be unable to accommodate you without a referral, however, unless you are willing to pay for the visit out of pocket.

Point of Service Collection

Payment for non-covered services, such as refractions or contact lens evaluations, are due at the time services are rendered. We accept cash, checks, and major credit cards for your convenience. Co-pays and all outstanding balances are also due at the time of service. If you have a question about your outstanding balance, our staff will be more than happy to assist.

Refractions

"Refraction" is a necessary procedure to evaluate your vision and/or write you a prescription for glasses. If you are experiencing blurred vision or decreased visual acuity as measured by the eye chart, a refraction would help determine whether the difficulty is associated with a medical problem or a need for glasses. During the refraction, the physician or technician offers you a series of lens choices until you reach the best corrected vision. Unfortunately, not all insurance plans cover this service and Medicare specifically excludes refractions as a covered benefit. The cost of the refraction is $45. This payment is due at the time of service for Medicare patients. For those patients with commercial insurance, we will submit the refraction claim and only bill you if your insurance company determines that you are responsible for payment.

Insurances Accepted

Virginia Adult and Pediatric Ophthalmology accepts insurance from most major insurance plans. Should you have any questions, please call (571) 210-5535. We do accept self-pay patients.

Prescription Refill

Please allow 2 business days to process refills. When you need refills for medications that our doctor has prescribed, please call your pharmacy. The pharmacy will contact Virginia Adult and Pediatric Ophthalmology, usually by fax (703) 376-8865, to obtain authorization for refills.