• Thank you for choosing us as your eye care provider

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  • ***** A NOTE TO ALL OUR CONTACT LENS WEARERS *****

  • In most cases, contact lenses are not considered "medically necessary" by insurance companies. Any costs performed to determine or update a contact lens prescription may not be covered by most insurance companies and will be the responsibility of the patient.

  • VISION INSURANCE

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  • MEDICAL INSURANCE

    (for any management of medical/routine care, i.e., diabetes, dry eye, eye infection,glaucoma, etc along with other testing or procedures) will be billed to your medical insurance. All co-pays and deductibles will be patient responsibility).
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  • MEDICAL RELEASE AUTHORIZATION AND INSURANCE ASSIGNMENT:

  • I, the undersigned, authorize payment from my insurance company to be made to Fowle Eyecare Associates PLC, for covered services. I understand that I am responsible for obtaining any referrals necessary before my appointment or I must pay in full for that visit. Regardless of my insurance status, I am ultimately responsible for the balance on my account.

    Should timely payments of this account not be made, I authorize Fowle Eyecare Associates, PLC, to retain the services of an attorney and/or collection agency to assist with the collection of any outstanding balance.  Any expenses incurred by such action shall become my responsibility.

    I certify that the information I have provided with regard to my insurance coverage is correct and further authorize the release of any necessary information, including medical information, to my insurance company in order to determine insurance benefits to which I may be entitled.

    This authorization may be revoked by myself at any time in writing.

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  • Medical and Ocular History Form

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  • Personal Medical History

    Do you have a history of any of the following conditions? Check those that apply:

  • Tobacco Use? and ?

  • Alcohol Use? and ?

  • Ocular Coherence Tomography

  • OCT technology is a new, state-of-the-art way to analyze and document the optic nerve and retina inside the eye. This quick, painless scan can give the doctor
    additional insights into eye diseases such as glaucoma, diabetes, macular
    degeneration and more.


    This "iWellness" test allows for earlier detection of these potentially sight­
    threatening conditions and offers information the doctor was previously unable to see with conventional techniques. This test, however, is not included in your vision or medical plan, and as a result, a $39.00 fee will be your responsibility for this enhanced level of service. For patients newly or previously diagnosed with related ocular conditions, the test can then be billed to medical insurance plans.


    The doctors at our office recommend the iWellness scan be performed on all adult patients.

    For questions on the scan please ask an/Fowle Eyecare staff
    member and they will be happy to assist you.

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