I understand and acknowlege the following:
- The Eye Center of Parkville follows HIPAA laws that protect your personal health information. I have been offered a copy of the Notice of Privacy Practices (HIPAA).
- I authorize The Eye Center of Parkville to bill my insurance company and receive payments.
- I understand I am financially responsible for all copays, deductibles and coinsurance amounts.
- I also authorize The Eye Center of Parkville to release any information needed for the processing of my claim.
- I understand that payment for all optometric professional services is due at the time of service.
- I understand that payment for eye glasses and contact lenses is due at the time of ordering.