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New Patient Forms

Download adult ophthalmology new patient forms.

Download pediatric new patient forms.

Insurance Plans Accepted

Abilene Ophthalmology Associates accepts most medical insurance plans but does not accept vision insurance.

Financial Policy

Payment is expected at the time of your visit for any co-payment/co-insurance amount, plus any deductible. If you do not have insurance or if your insurance sends payments directly to you, then payment in full is due at each visit.

For your convenience, we accept Visa, MasterCard, Discover, cash or check.

Should an over-payment occur on the deductible or percentage amounts charged, we will apply a credit to your account. If you have an appointment within the next 60 days, the credit is applied to your account and can be used at that visit. If no further appointments are needed, a refund check for the credit amount will be mailed to you.

You will also be asked to make a payment on any outstanding balance at the time of your visit. Patient balances after insurance processing are due within 30 days.

Please let us know if you have any questions regarding your account.

NSF (non-sufficient funds) checks are sent to InstaChek for collection. A service fee of up to $30 is charged on all returned checks in addition to the amount of the check.

Each patient will be asked to sign a statement of agreement with our Financial Policy upon arrival in one of our offices.

Privacy Rights

The Notice of Privacy Rights describes how medical information about you may be disclosed and how you can get access to this information. As our patient, under HIPAA (the new federal privacy act), you have specific privacy rights. We are required by law to provide you a copy of the notice and obtain your signature verifying that we did so. Each patient will be given this notice upon arrival in one of our offices, and will be asked to sign an acknowledgement of receipt.

If you would like to obtain the Privacy Notice and sign the acknowledgement form prior to your arrival, you may download them both now, read the notice, print the acknowledgement form, sign it, and bring it into the office with you. Download the Privacy Notice. Download the Spanish Privacy Notice. Download free Adobe Reader.

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