CLIFTON PARK EYE CARE ASSOCIATES
New Patient Information and Forms
Prior to your appointment, please print out and bring with you the Patient Information, Patient Medical History, and Dilated Eye Consent/Payment Policy Forms. Please read through the HIPPA form, you do not need to bring this form with you.
Do Not Need to Print
In order to ensure a smooth and timely appointment, please bring with you:
1. Completed Paperwork
2. Insurance Cards (it is suggested that you contact your insurance prior to your appointment to confirm whether or not your appointment is a covered service. Also, your insurance company can tell you if you have any material benefit that you may want to use toward your eyewear purchase)
3. List of all current medications and pharmacy information
4. Current eyeglasses, prescription sunglasses, or written prescriptions you may have
5. Contact Lenses (if you are a current contact lens wearer, please be aware that you will need to remove them for your exam. It is also helpful to bring the contact lens box or written contact lens prescription with you, so that the doctor can be aware of what you have been using.)
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Eyewear Purchase Information
We participate with VSP, CDPHP, MVP, Aetna, Medicare, most Blue Cross/Blue Shield plans, and MOST Eyemed plans. We do NOT participate with Fidelis, Medicaid, MVP Medicaid, CDPHP Medicaid, Davis Vision, United Health Care, or Superior Vision.
