New to Conestoga Eye?

We’re making check in easier. 
Complete your new patient paperwork before your appointment in just a few easy steps.

Call Conestoga Eye to create your Patient Portal Account.

Conestoga Eye strongly encourages that patients set up their portal account and fill in medical history from the comfort of their own home before their appointment. Completing the forms via the portal, before visiting the office, will help to streamline your experience. Call 717.541.9700 today.

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.

Please read!

Please remember to save your completed PDF to your computer. Email your saved PDF to Emailing the PDF directly to the office from your internet browser will result in a loss of the information.

Download New Patient Forms to Print.

Prefer the classic way of completing your paperwork? Download the plain PDF version of Conestoga Eye’s forms below and return the hard copy to our offices. Feel free to email them before your appointment to If not, please bring them to your visit.

   Download Now

Request a Hard Copy.

If you need a hard copy of Conestoga Eye’s New Patient forms mailed to you, please call 717.541.9700 today.

Before Your Appointment.

If you would prefer to complete all of Conestoga Eye’s paperwork before your appointment, please arrive at the office at least 20 minutes early.


At your appointment you will be asked to sign our consent for treatment and financial policy as well as our Notice of Privacy Policy. To view our notice of privacy policy, please click here.


Updated on 2017-01-25T22:14:24+00:00, by admin.