Patient Forms

PLEASE CLICK BELOW TO FILL OUT YOUR MEDICAL HISTORY PRIOR TO YOUR APPOINTMENT.

If you are a minor, you must have a guardian with you during your appointment or a written consent from the parent stating that the individual can be examined with permission. We will try out best to notify you of all copays before the exam, but it is your responsibility to know your coverage. Any consent document must be received prior to examination.

ADA COMPLIANCE

Today's Vision Manvel is committed to providing a website that is accessible to the widest possible audience, regardless of circumstance and ability. We aim to adhere as closely as possible to the Web Content Accessibility Guidelines (WCAG 2.0, Level AA), published by the World Wide Web Consortium (W3C). These guidelines explain how to make Web content more accessible for people with disabilities. Conformance with these guidelines will help make the web more user friendly to everyone. Whilst we strive to adhere to the guidelines and standards for accessibility, it is not always possible to do so in all areas of the website and we are currently working to achieve this. Be aware that due to the dynamic nature of the website, minor issues may occasionally occur as it is updated regularly. We are continually seeking out solutions that will bring all areas of the site up to the same level of overall web accessibility.

If you have any comments and or suggestions relating to improving the accessibility of our site, please don't hesitate to contact our accessibility coordinator tvmanvel@todaysvision.com

Your feedback will help us make improvements.

GOOD FAITH ESTIMATE

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

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 medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

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, or call 1-800-985-3059.