Name     Contact Phone     Name of Insurance Plan     Reason for Visit

Note: Most HMO insurance plans require a referral to see a specialist. If your insurance plan requires a referral form your primary care physician, you must bring the form with you to your appointment or have it faxed to us at 703-753-2183 prior to your appointment. We are not responsible for denied claims if no referral was obtained.

Please notify the office 24 hours in advance if you need to cancel or reschedule your appointment. Failure to do so will result in a $50 cancellation fee.

Please download the new patient registration form above and bring it with you to your first appointment. If you do not fill out the new patient registration form in advance, please arrive 15 minutes early for your appointment.

New patients should allow 60-90 minutes for an initial comprehensive eye exam. Your eyes will be dilated, resulting in blurriness and sensitivity to light for several hours. You may want to have someone drive you to this appointment.

You may request a new glasses prescription (also known as a refraction) during your visit. However, many insurance plans (including Medicare) do not cover refractions. If your insurance plan does not cover refractions, there will be a charge for this service.

If you have glasses, please wear them to your appointment.

Contact lens fittings will be scheduled as a separate appointment after a comprehensive eye exam has been completed. They are not covered under medical insurance plans.