Patient History Update

Please carefully complete our questionnaire. This form does not need to be printed, once submitted, we should receive it on our end. The information supplied will allow for more efficient use of time and will permit us to make a complete optometric evaluation of your visual system related to your specific needs. 

48 Hour Cancellation Policy

We realize that emergencies and other scheduling conflicts arise and are sometimes unavoidable. However, advance notice allows us to fulfill other patient’s scheduling needs and keeps the clinic operating at is most efficient level. Due to our 60-minute exams missed appointments are a significant inconvenience to your doctor, the clinic and other patients.

This policy is in place out of respect for our doctors and our clients. Cancellations with less than 48 hours notice are difficult to fill. By giving last minute notice or no notice at all, you prevent someone else from being able to schedule into that time slot and leave a 60-minute hole in the doctor’s schedule.

  • Please provide our office with 48-hour notice to change or cancel an appointment. Patients who do not attend a scheduled appointment or do not provide 48-hour notice to change a scheduled appointment will be responsible for a $75.00 service chargeThis charge cannot be billed to insurance and must be paid before scheduling your next appointment.
  • We reserve your one-hour appointment time just for you. We do not double-book our patients so that we may provide optimum treatment outcomes for all our patients. 48-hour notice allows us to offer that time to a wait-listed patient.

NOTE: You will never be charged for a cancellation if it is made more than 48 hours in advance of your scheduled appointment time.

Thank you for providing our office and our patients with this courtesy.

Sincerely,

Drs. Garbus & Benosa, and the Family Vision Care Staff


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Appointment with:
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Have you seen another eye doctor since your last office visit?
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Blurred Vision: Distance or Near
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Irritation
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Are you interested in Contacts?
Glare or Distortion in your vision
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Allergies
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Arthritis
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Headaches
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Diabetes
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Disorientation / Dizziness
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High Blood Pressure
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Stroke
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Traumic Brain Injury / Concussion
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Thyroid Disease
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Please let us know if you have/had any of the following symptoms within the last two weeks
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24 Hour Cancellation Policy

Please do not submit any Protected Health Information (PHI).

Hours of Operation

Monday  

9:00 am - 6:00 pm

Tuesday  

9:00 am - 6:00 pm

Wednesday  

9:00 am - 6:00 pm

Thursday  

9:00 am - 6:00 pm

Friday  

9:00 am - 6:00 pm

Saturday  

Closed

Sunday  

Closed

Location

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