INSURANCE INFORMATION Please enable JavaScript in your browser to complete this form.We often have patients that have both vision and medical insurance. They are very different in terms of the services they cover and it’s important for our patients to understand those differences. Vision coverage is mainly designed to determine a prescription for glasses, help pay for eyeglasses or contact lenses, and to evaluate the health of their eyes. It is not designed or equipped to deal with medical conditions, diagnoses, and/or treatment plans. When a medical diagnosis or condition is present (such as high blood pressure, diabetes, or an eye disease such as infections, dry eyes, allergy, and cataracts, to name just a few) it is necessary to file the claim for your visit with your major medical carrier and the co-pays for that insurance will apply as well as any non-covered service. Vision insurance does not cover medical eye problems, just as medical insurance does not cover routine vision problems. Our office does not make these rules, they are defined by the insurance carriers themselves. There is no way to know prior to the examination which type of insurance will apply or with whom our office will be able to file a claim for you. We make every effort to be a provider on every major medical, vision insurance, we will provide you with an itemized receipt so that you may file with your carrier for reimbursement. If you have any questions, please let us know.I understand the paragraph above and authorize BarKing Optical, Inc to file a claim with my insurance.Print Name *FirstLastSignatureClear SignatureDateWebsiteSubmit