Request an appointment.


New & Returning Patients

Patients requesting an appointment should complete the form. Once completed and submitted, a member of the Conestoga Eye team will contact you to set up your appointment and confirm your information.

Please fill out the form as completely as possible.

 

The first time you visit our office, you will be asked to sign the HIPAA NPP.
To read our NPP, please click here.


Regular eye examinations are important to maintain your vision for your lifetime. At Conestoga Eye, we believe it is important you are aware of your insurance benefits and how they apply to your visit. We have prepared this sheet to help you understand how your visit is submitted to your health insurance or vision insurance for today’s visit. Benefits may vary based upon the reason for your visit.  

Routine Eye Examinations   A “routine eye exam” takes place when you come for an eye examination without any medical complaint, symptom, or condition which affects the eye. The doctor checks your vision, determines your eyeglass and/or contact lens prescription, and screens the eyes for disease. Examples that will necessitate your visit being submitted as a vision exam include:

  • Basic eye exam
  • Glasses / Contact Lenses

Medical Eye Examinations   Your visit will be coded and billed as a “medical eye examination” whenever you are being evaluated or treated for a medical condition or symptom that you bring up, eye problems you tell our staff about, or a condition that the doctor finds in the examination. Examples that will necessitate your visit being submitted as a medical exam include but may not be limited to:

  • Blurry Vision related to a medical diagnosis or condition
  • Diabetes mellitus/Hypertension
  • Dry, redness, or irritation of eyes
  • Allergies
  • Headaches
  • Floaters and/or flashing lights
  • Contact Lens intolerance
  • Glaucoma
  • Referral from outside physicians
  • High risk medications (auto immune, systemic illness treatment)
  • Cataracts
  • Eye muscle imbalance
  • “Lazy eye”
  • Macular degeneration

The purpose of your visit will determine which insurance benefit will be used. If your doctor determines that your problem falls under the category of a “medical eye examination”, your visit may be billed as a medical exam instead of a routine vision exam, which will be subject to co-pays and deductibles according to your medical insurance plan. You will be informed of this determination during your visit with the doctor. You will then have the option to pay out of pocket for your refraction (glasses/contact lens prescription) or schedule a return appointment, using your applicable vision insurance.


Patient's Name*

Patient's Date of Birth*

I am a

Appointment Type

Patient Guardian Name (if patient is a child under 18)

Patient Phone Number

Insurance Carrier

Preferred Appointment Date/Time

Is there anything we should know?

Request an Appointment

Updated on 2017-12-23T15:40:40+00:00, by admin.