Contact Lens Fitting/Evaluation Agreement The fee for contact lens fitting and evaluation by Bright Eyes Vision is not included in your comprehensive eye exam. Contact lenses are medical devices and even though they may feel fine, there are health risks that must be taken seriously. Additional tests are necessary to make sure your eyes are healthy and that your lenses fit properly. Contact lens professional fees are for the extra testing and time taken by the doctor and staff each year to properly evaluate your lenses. Explanation of Exam Type and Fees. Contact Lens Fitting: This is necessary for all patients new to contact lenses. The price depends on the type of contact lens that is determined best for your eyes and visual needs. The fitting also includes the instruction on insertion, removal, and care of the contact lenses. The fee includes the initial visit and up to three subsequent visits directly related to contact lens wear and fit within a 90 day period for soft contact lenses. Contact Lens Refitting: This is necessary for established contact lens wearers that do not know their exact lens parameters or when a new contact lens type/brand is needed. Review of instruction on insertion, removal, and care of contact lenses are also included, if needed. The fee includes the initial visit and up to three subsequent visits directly related to contact lens wear and fit within a 90 day period. Contact lens evaluation: This exam is necessary every year for all current contact lens wearers. It includes evaluation of your current lens fit and power as well as changes in power if necessary, but not a change in type/brand. Gas permeable lenses are warrantied for adjustment from the lab. Based on how the lenses fit on your eyes, the initial lenses given to your may be warranty period. It is important that you arrange timely visits to the office so your lenses can be evaluated for possible modification during that warranty period. Failure to be seen during that period will void the warranty and changes or returns will not made. *** The cost of your contact lens materials is separate from the fitting fee and varies on the lens type*** If you do not wish the doctor to evaluate your current contact lenses, you may remove them before being seen, but you will not be eligible for a “contact lens prescription.” Common Questions What are some of the risks associated with contact lenses? One of the major risks associated with contact lenses is infection. Often, complications associated with contact lens use can be avoided with proper handling as well as an acceptable wear schedule. Sleeping with contact lenses increases the risk of problems as does swimming with lenses. Because contact lenses are medical devices proper care and use of the lenses is imperative for maintaining eye health. How long is a contact lens prescription valid? One Year What solutions should I use? Not all solutions are compatible with every contact lens. Please use the solutions that is recommended by our doctors. Mixing different solutions may even be harmful to your contact lenses. If you have a question about solution, please ask. Why should you get your lenses through Bright Eyes Vision? Bright Eyes Vision’s pricing is competitive with other places including online retailers and we can provide you in many cases with rebates that other retailers do may not have. If you tear a soft lenses, we will get you additional lens at no charge to you Will my vision plan cover my contact lens fitting? This depends on your specific vision plan. There are many plans that contribute to the contact lens evaluation/fitting, but not all. Many plans will cover either glasses OR contact lenses, but not both. * Please sign below that you understand and agree to pay fees at the time of service. I understand that a contact lens evaluation must be performed at least once a year for the sake of the health of my eyes. I acknowledge that my contact lens prescription can only be released after the initial fitting period is successfully completed and all fees are paid.Name First Last Patient or Guardian SignatureDate MM slash DD slash YYYY Δ