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Patient Forms

SERVICES FOR HEARING IMPAIRED AND NON-ENGLISH SPEAKING PATIENTS OFFERED AT OUR UVA CLINIC ONLY.
Prior to your visit, please download and complete the following forms. For your convenience, you may choose to download all of the forms in one document at this link.

Adobe Acrobat Reader is required to print these forms. If you do not have this free program you can download it here.

What to bring to your appointment

We request that you arrive 15 minutes prior to your scheduled appointment to ensure that all paperwork is properly completed. Please bring the following items with you to your appointment:

  • Completed patient forms
  • Insurance card(s)*
  • Medicare/Medicaid card(s) as appropriate
  • Current eyeglasses
* Your insurance cards are very important as we must confirm coverage and verify the accuracy of all information before the eye exam takes place.

Insurance

Albemarle Pediatric Ophthalmology and Strabismus accepts many health insurance providers. The list below represents some of the more common companies that cover our patients. If your health insurance provider is not listed below please give us a call and we will be able to confirm whether or not we will be able to accept your health insurance.

  1. AETNA
  2. MEDICARE (Non-participating)
  3. ANTHEM
  4. OPTIMA
  5. ANTHEM HEALTH KEEPERS
  6. OPTIMA FAMILY CARE (Medicaid)
  7. CIGNA
  8. TRICARE (Non-participating)
  9. INTOTAL HEALTH
  10. VIRGINIA PREMIER (Medicaid)
  11. MEDICAID (Virginia)
Our office does not participate with any vision insurance plans. Insurance may not pay for an examination if there is no medical diagnosis.

Eye Exams

Each eye examination will include a thorough assessment of vision and ocular health regardless of the patient’s age.