Optomap Consent Form

Optomap Consent Form

Retina Imaging Policy

By choosing Fishbaugh Family Eyecare, you have entrusted us to care for your eyes:

We take this responsibility very seriously.

We pride ourselves on providing our patients with the best possible standard of care.
Because of this, we now perform the OptomapĀ® Retinal Exam on all of our patients.
The Doctors strongly believe that the optomap Retinal Exam is an essential part of your comprehensive eye exam and prescribes it for all patients once per year.

It is our belief that an eye exam with Optomap imaging provides the HIGHEST Standard of Care.

Today, we will perform this fast, easy and comfortable screening test as part of your annual comprehensive examination. The $30 cost for this imaging is not covered by insurance companies and would be in-addition to your examination fee or vision plan co-pay.

By offering the optomapĀ®, the doctor MAY NOT need to dilate your eyes.

Any questions you have about the OptomapĀ® Retinal Exam can be directed to the doctor when the images are reviewed during your examination.

Thank you for allowing us to monitor the health of your eyes: Remember, they are the only two you have, and that is why we take your eye care seriously.

Sincerely-

The Doctors and staff of Fishbaugh Family Eyecare

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