Patient Forms

Access our patient forms. Please fill out before your next visit to Eye-N-Eye Vision Center.

Good Faith Estimates

Under the law, if you do not have medical insurance or choose to not utilize your medical insurance for specific episodes of care provided, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like office visits, medical tests and medical equipment
Your Good Faith Estimate must be made in writing at least 1 business day before your medical service or item. In the event the care is emergent or testing recommended during an office visit, your GFE will be provided at the time your additional services are offered.
You can ask your health care provider for a Good Faith Estimate before you schedule an item or service although this will be just an estimate as the exact care you need cannot be determined until your doctor evaluates you.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises

Patient Forms

Access our patient forms. Please fill out before your next visit to Eye-N-Eye Vision Center.

Online Patient Questionnaire:

Welcome Forms:

Other Forms:

Good Faith Estimates