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Contact Lens Policy Consent Form


    Advancements in contact lens technology offer the potential of successful contact lens wear to most of our patients. A contact lens is a medical device in contact with the tissues of our eye, therefore, it must fit appropriately to maintain the health of your eyes. A contact lens prescription can only be determined by the careful observation of the lens on the eye and the eye's response to the lens on follow-up visits. Since follow-up care is essential, it is your responsibility to keep all appointments and follow all lens care instructions. 


    Before a patient can be fit with contact lenses, a complete medical and refractive eye examination is necessary. This exam is critical to assure the good health of your eyes and to rule out the possibility of any unsuspected, underlying condition that may prevent contact lens use. Upon the completion of the comprehensive eye exam, qualified patients will proceed with the contact lens fitting. 


    The goal of contact lens fitting is to find the most appropriate contact lens for each patient's optimal vision and comfort. With such a wide array of contact lens types, materials, sizes, curvatures, and wearing regimes, it is critical that a complete fitting and analysis occurs to ensure a proper fit. All patients being fit into contact lens for the first time must go through the fitting process. This will frequently include keratometry (corneal curvature measurements), tear film function, and slit lamp biomicroscopy analysis of the cornea and surrounding tissue. We will not finalize the contact lens prescription until both the patient and doctor are satisfied with the fit and visual acuity of the contact lens. We will provide one set of trial lenses. Any patients who are changing lens brands must also have a new fitting. A contact lens fitting does not have to be performed on the day of the comprehensive eye exam but must be performed within 60 days from that date, 


    The patient will be provided with personalized instructions concerning the safe care and usage of contact lenses. Upon completion of successful insertion and removal, the patient may begin wearing the contact lenses and we will schedule the first follow-up appointment within 1-2 weeks. 


    In order to receive your contact lens prescription it is essential and your responsibility to maintain follow up appointments and follow all lens care instructions. With each contact lens exam, you will be provided up to two follow-up visits at no additional charge. Each additional follow-up visit will cost $25; payment must be made prior to follow-up visit. The doctors and staff at Fusion Eye Care value your time and make every effort to be prepared for you at the time of your appointment, therefore, we expect the same amount of respect for our time. Any missed appointments without a 48 hour notice will deduct from the allotted amount of follow-up visits and/or cost $25. We kindly ask that you keep your follow-up appointments. 


    All contact lens prescriptions are valid for one year from the date the prescription is finalized. All patients are required to come in for an annual contact lens exam if they would like their prescription renewed. This is necessary to assure that the patient's eyes are healthy and the contact lenses are still fitting well. Contact lens exams have a separate charge and are not included in a medical or vision exam. 



    The contact lens fitting fee includes: 

    • The contact lens fitting 
    • Insertion and removal training 
    • Contact lens care education - $50 
    • Two free follow-up visits that must be made within 30 days of contact lens fitting date 
      • $25 charge for contact lens follow-ups after the initial 2 free visits 


    Fees for the comprehensive eye exam, contact lens fitting, or annual contact lens evaluation are due at the time of service. We require payment in advance for all contact lens orders, with the exception of trial lenses. We accept cash, Visa, Mastercard, Discover, and American Express. With a valid prescription, we will gladly complete a contact lens order for you over the phone. 


    There will be no refund on professional services or opened box contact lenses. With management approval, unopened contact lenses boxes may be refunded minus any annual supply discounts. 


    Although our contact lens policy is effective without a signature, we kindly ask that you sign below to help our staff identify which patients may need a copy of our contact lens policy for their records. We thank you.