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Spring Hill Eyecare, PLLC

Patient forms / what to bring

Thank you for choosing Spring Hill Eyecare, PLLC!

 

 

To save time, print and fill out the following forms prior to coming to the office

1.  Welcome Form for Adults

2.  Welcome Form for Children  

3.  Visual Needs Questionnaire  

 

Also, please bring the following:

1. Your current pair(s) of glasses - even if you feel the prescription is not correct or if the frame is damaged.

2. Your current contact lens parameters - bring the boxes the lenses came in.  Also, know the name of the solution you use. 

 

If unable to print out the patient forms ahead of time, please arrive 10-15 minutes prior to your appointment time to fill out the forms in the office.  You will need to know the following :

1. A list of your current medications & dosages - both prescription & over-the-counter.

2. Your medical or vision insurance cards, if applicable.  Please call ahead to see if we are currently accepting your plan. 

3. Contact information about you (or your child): name, home/work addresses, home/work/cell/emergency phone #s, social security #.

4. Date of last medical and eye exams.  Names of your primary care physician and previous eye doctor. 

5. History of any medical or eye diseases for you and your immediate family (parents, siblings, children, grandparents, aunts/uncles).

 

 

In our continued efforts to bring the most advanced technology available to our patients, Spring Hill Eyecare, PLLC is proud to offer the Optomap retinal exam as an integral part of your eye exam.

 Retinal problems, including macular degeneration, glaucoma, retinal holes or detachments and systemic diseases such as diabetes and high blood pressure may all be detected with this new technology.  The Optomap is fast, easy, and comfortable.  The Optomap enables us to see nearly all of your retina.  Furthermore, it usually eliminates the discomfort and inconvenience associated with pupil dilation.  As a result, you will not experience blurred vision or sensitivity to light following your eye exam.  It is important to note however, that should any abnormalities be detected or if we cannot obtain an acceptable image, dilation may be necessary.

An Optomap exam provides:   

· An eye wellness scan

· An in depth view of the retinal layers (where diseases can start)

· The ability for you to view your Optomap retinal image with Dr. Szeliga during your exam

· An annual, permanent record for your medical file, which gives your doctor comparisons for tracking and diagnosing potential eye diseases.

Dr. Szeliga highly recommends the Optomap retinal exam annually for ALL patients.  Because your insurance only covers a basic eye exam, advanced screening tools such as the Optomap are not typically covered.  This enhancement to your general eye exam costs only an additional $30 for patients with insurance.  It is already included in the private pay cost.  To read more about the Optomap retinal exam and what to expect during your eye examination, please follow this links:

· Services Provided: Optomap Retinal Exam

· Spring Hill Eyecare First to Offer Revolutionary Modality for Retinal Disease Detection to Patients in Spring Hill

 

Again, thank you for choosing Spring Hill Eyecare, PLLC.

We look forward to seeing you!

© 2008 Spring Hill Eyecare, PLLC

5328 Main Street                  

Spring Hill, TN 37174        

931-489-1950

615-302-1650