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CVO is proud to offer the best possible care for their patients. Because of this, we recommend the Optomap for every one annually. Sometimes referred to as ultrawide imaging, Optomap gives your doctor a nearly complete view of your retina and allows for state-of-the-art assessment of the overall health of your eye by allowing your doctor to see things out in the far parts of your eye that might otherwise be missed such as tumors, tears, and detachments. Dilation, which is part of every thorough eye examination, allows your doctor to see the back of your eye in 3-dimensions and with a level of details not otherwise possible. Together, Optomap and Dilation provide the greatest level of assurance that the back of your eye is thoroughly evaluated.

Your doctor recommends that you get dilation in addition to the Optomap image.

Please SELECT an option below*

I ELECT to have both DILATION (no additional cost) and OPTOMAP RETINAL IMAGING for $25.I ELECT to have OPTOMAP RETINAL IMAGING for $25 but I am DECLINING DILATION. I understand that this increases the risk of partial or total loss of vision due to undetected eye disease.I DECLINE the OPTOMAP RETINAL IMAGING but I am CHOOSING to be DILATED.I DECLINE both OPTOMAP RETINAL IMAGING & DILATION. I understand that this creates the greatest risk for partial or total loss of vision due to undetected eye disease.

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Please be advised that any records and all finalized prescriptions, spectacle, contact, or otherwise, will be uploaded and made available to you electronically via your Patient Portal.

You can access and register for this portal at: www.mysecurehealthdata.com.

By signing below, you acknowledge and accept electronic receipt of prescriptions and records.

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