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WELCOME TO THE EYE CENTER

PATIENT INFORMATION

* IF UNDER 18 YEARS OF AGE:

WHOM MAY WE THANK FOR REFERRING YOU TO OUR PRACTICE?

PAYMENT POLICY - Please read carefully

We will need a copy of your insurance cards!

Please let us know what insurance you have so that we can determine if we are providers prior to your examination.

Fees for professional services are due when services are rendered.

When materials are necessary, glasses or contact lenses, at least half of the total fee is required to place the order. The balance will be due upon delivery. Should your account become delinquent, and require legal collection efforts on behalf of our collection agency or settlement via small claims court, a “delinquent account fee” will be added to your account balance.

The “Delinquent Account Fee” is $50.00

The “Returned Check Fee” is $25.00

We are happy to accept Visa, MasterCard and Discover!

I have read, understand and agree to the above terms and understand that I am responsible for any fees incurred.

INSURANCE SIGNATURE ON FILE - Long Term Authorization

I request payment of authorized Medicare and /or Major Medical and/or Vision benefits be made on my behalf to Drs. Ward and Hall

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY POLICY

I acknowledge that I received a copy of the “Notice of Privacy Practices” for The Eye Center

We must have a copy of all of your insurance cards, including Medicare (red, white and blue card) and Medicaid (blue and white card).

*Note: This is only a general summary of exclusions from Medicare benefits. It is not a legal document. The official Medicare program provisions are contained in relevant laws, regulations and rulings.

I consent to the specified service and understand that I will be responsible for the estimated cost of the service.

Exclusive Offer

Now booking new patients. Contact us today!

Office Hours

 South Tulsa

DayMorningAfternoon
Monday8:00am5:00pm
Tuesday8:00am5:00pm
Wednesday8:00am5:00pm
Thursday8:00am5:00pm
Friday8:00am5:00pm
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00am 8:00am 8:00am 8:00am 8:00am Closed Closed
5:00pm 5:00pm 5:00pm 5:00pm 5:00pm Closed Closed


 


 


 

 Okmulgee

Monday 8:00 am 5:30 pm
Tuesday 8:00 am 5:30 pm
Wednesday 8:00 am 5:30 pm
Thursday 8:00 am 5:30 pm
Friday 7:00 am 5:30 pm
Saturday Close Close
Sunday Close Close