Family Eye Care in Dedham, Natick, and our NEW location in Boston!
Schedule An Appointment
Patient Consent Form
Patient Registration Form
Comprehensive Eye Exams
Pediatric Eye Care
Dry Eye Assessments
Emergency Eye Care
Contact Lens Info
Contact Lens Fitting
Contact Lens Care 101
Soft Contact Lenses
Gas Permeable Lenses
Patient Consent Form
To expedite your registration process, we are offering online registration forms for your convenience. Please feel free to complete these forms prior to your scheduled visit - so that you do not have to complete them upon your arrival.
We will make every effort possible to bill your exam to your health or vision insurance. However, if your claim is denied and we find ourselves unable to process the claim further, it is the patient responsibility to pay any balance due. I understand that non-payment of my balance will place me at risk of being reported to a collection agency.
I have read and understand this statement.
I have read the statement and wish to speak to a Doctor about it.
As part of our comprehensive exam, our optometric technicians will take photos of the back of the eye for all of our patients. These photos provide the doctors with a great deal of information regarding the health of one's eye.In some cases, it can even be an alternative to having your eyes dilated. These photos, however, are sometimes not covered by health or vision insurance and are an additional $40 charge. The charge will only be incurred if the patient wants the doctor to interpret the results. If you choose not to have the results interpreted, the doctor may choose to dilate your eyes.
Retinal Photography | Eye Dilation
I want the doctor to interpret the results of the photos for me.
I do not want the doctor to interpret the results and prefer to have my eyes dilated.
I do not want the doctor to interpret the results and I do not wish to have my eyes dilated. I assume all liability, if there is an issue.
I would like to talk to the Doctor for more information.
We like to assist our patients in every way possible. This is why we automatically set up your annual eye exam for you. If this is a service you do not wish to receive, please indicate in the box below.
Appointment Reminder Program
YES - I wish to take part in the appointment reminder program.
NO - I DO NOT wish to take part in the appointment reminder program.
Save and Continue Later
Patient Portal Information
Medicare Guidelines for Eye Care Services
Accepted Insurance Plans