Our clinic is pleased to announce that we will be offering a new way to contact you in the near future. Please take a moment to fill out the section below:
*Please note that missed or cancelled appointments with less than 24 hours notice will incur a $50 fee
Patient Consent Requirement: By entering my name below I understand that the personal information collected about me (and/or my family) and held by 20/20 Eye Care shall be limited to that which is necessary for the provision and billing for optometric services and communication with me, authorized health care providers or insurers relating to that care. I understand this information may also be disclosed to the practice’s consultants or other persons contracted to maintain the practice’s business, to a succeeding or purchasing optometric or medical practice, or to regulatory authorities for the purpose of complaints, investigations, or stand reviews. I understand that the practice will keep my personal information confidential and secure. I hereby authorize 20/20 Eye Care to collect, use, and disclose my personal information as described above.
