What is the reason for this visit?

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Please enter your personal information

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Additional Notes

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Please Enter your Medical Insurance Information

BlueCrossBlueShield, United Healthcare, Cigna, Aetna, etc

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Please Enter Your Vision Insurance Information

Medical insurances typically outsource vision to a group such as VSP, Eyemed, Spectera, Superior, etc.

Enter your vision insurance if any

Review and Submit

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  • 1. Personal Details
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  • 2. Appointment details
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