CONTACT LENS EXAMINATION - DECATUR A standard contact lens exam includes clear, soft, spherical, daily wear contact lenses for single-vision prescriptions. It does not include extended/overnight wear lenses. A premium contact lens exam includes more complex applications, including, but not limited to, bifocal/multifocal soft and cosmetic color, extended/overnight wear lenses/Gas Perm/Hybrid lenses, These fees range from $75 -$95 for soft exam and $150-$250 for hard fitting. New Wearers: additional $30 added to U&C fees. Mandated by the FDA, in the state of Georgia, a contact lens prescription expires 1 year from the date the lenses were prescribed, even when the type of lens or prescription you are wearing does not change. Therefore, a contact lens examination is required annually. No contact lenses will be prescribed until the doctor feels that the lenses are appropriate for you regarding fit, vision, comfort, and the future health of your eyes. Therefore, it is very important that you follow all directions regarding the care and wear of your lenses, and return as needed for all scheduled progress evaluations. As with any drug or device, the use of contact lenses is not without risk. Though not common, a very small percentage of individuals have developed serious complications which can lead to permanent eye damage. If you have any unexplained eye pain or redness, watering of the eye or discharge, cloudy or foggy vision, a decrease in vision, or an increased sensitivity to light, remove your contact lenses immediately and make arrangements to see us before wearing your contact lenses again. We will try our very best to fit you into the best lenses appropriate for your visual needs, desires, and lifestyle, but due to many variables, there is no guarantee that you will be successful with wearing contact lenses. Contact Lens fitting fees is non-refundable. Contact lens follow-up examination(s) are $20 for soft contact lenses and $40 for hard contact lenses up to 45 days from original date of fitting. At 46 days or more, any contact lens visit is considered a new fitting and will be charged accordingly. Feel free to ask your eye associate for contact lens examination pricing. If during a follow-up visit it is determined that you require an upgraded lens, there may be an additional charge for the difference between the standard contact lens fit and the upgraded premium contact lens fit. Eyeworks has a 60 day contact lens exchange policy for soft contact lenses. Eyeworks will exchange contact lens product for a different contact lens brand purchased through Eyeworks (as long as package is original, unopened and unaltered) for another brand within 60 days of purchase. No refunds will be given but credit can be applied towards the exchange. Specialty contact lens exams include (but are not limited to) hybrid, scleral, gas permeable lenses. Keratoconus CL exams/fittings are higher (ask your optician) but could be deemed medically necessary by your insurance company.We will assist with paperwork if we feel we can get this approved for you. Specialty Contact Lenses have a 75 day warranty. After that time, they cannot be exchanged so it is important that the patient be compliant with follow-ups and doctor’s orders. Follow up fees after 90 days but before 120 days will be between $40 and $100/per appointment, depending. Contact lens fees vary depending on type of fit necessary. If your vision insurance covers contact lens fittings, the discounts, co-pays and allowances are dictated by your insurance company and payment is required when services are rendered. I have read and understand the information on my contact lens exam.Patient Signature*Name* Date Initials* NameThis field is for validation purposes and should be left unchanged.