Forms

financial_policy.pdf
notice_of_privacy_practices.pdf
q&a_dilated_exam.pdf
registration_form.pdf

Thank You for choosing Northeast Wisconsin Vision Center for your eye care needs.  We, the doctors and staff of Northeast Wisconsin Vision Center, are pleased to have the opportunity to serve you.  We understand the value you place on your vision and are honored by the trust you place in us.

Please take the time to print and fill out the forms in their entirety using black ink and bring completed forms with you on the day of your appointment.  These forms are necessary for our staff to provide the highest quality of care.

Please arrive 15 minutes prior to your appointment, and stop at our reception desk with your current medical and vision insurance cards.  If your insurance requires that you pay an office co-payment, such payment is required at the time of your service.  We also advise that you contact your insurance plan to make sure we are a preferred provider covered by your plan and to make sure you don’t need a referral from you primary care physician prior to your appointment.  Please read and sign the financial policy attached.

Please bring the following to your appointment:

Insurance cards
Completed forms
Co-payment
List of current medication
Current glasses, contacts and contact solutions
All current eye medication bottles

*OFFICE LOCATIONS:     Toll Free 1-800-876-8182