Annual Patient Information

Emergency Contact:

We ask that all patients read and sign our financial policy prior to seeing the doctor.
1. Payments and all co-payments are due at the time of service.

2. You will be responsible for all charges that are not covered by your insurance due to co-payments or deductibles.
3. There are no refunds for examinations, treatment, services or material purchases.
4. There will be a $30.00 fee for all returned checks and/or turning an account over to our collection agency and additional interest fees may also apply to accounts older than 60 days.

There are two types of third party payors that will help pay for your eye care services and products. You may have both and our practice accepts both. The choice of which to bill is driven by your medical and eye history and/or your symptoms or issues brought up during the exam.

I hereby authorize third party or insurance payments to be made directly to Accent Vision Specialists and fully understand that I am the responsible party for all fees incurred by me at the above mentioned facility. I also authorize the release of any information required for the processing of those claims. I, the undersigned, have read and agree to the above policies.