PATIENT FORMS & INFO

Please fill out the following forms and bring them to your next appointment. Thank you.

Check-In / Privacy Practices Form

Medical History Form

Notice to all of our EyeMed Insurance patients:

Unfortunately due to no response, after 90 days from EyeMed Insurance reimbursement department, in which we were asking for a reevaluation of our reimbursement rates.

Redlands Optometry Group will no longer be an in-network provider for EyeMed Insurance as of August 31, 2023.

Beginning September 1, 2023 we will only be able to schedule patients with this insurance as an out-of-network provider. We are sorry for any inconveniences this may cause.

This decision was not easy for us to make, as many of you have been with us for a very long time and we hate to lose you as our patients. But due to increasing costs of doing business and EyeMeds refusal to update the reimbursement rates since we signed on with them in 2008.

We cannot continue to provide the same level of eye-care that we strive for at the 2008 prices they pay us.

For all patients that have appointments scheduled after 09/01/2023 please contact the office ASAP to verify that you would like to keep your appointment.

You will need to pay privately and submit your receipt to EyeMed yourself or if you have a secondary vision insurance that you would like to use instead, so we can update the scheduler.

We are attempting to reach out to all of our patients and apologize if anyone was missed. Please contact the office before September 1st or your appointment will be canceled. We hope to be able to see you in our office for your future appointments.

Please reach out to your Human Resources department to make any changes to your vision plan as open enrollment is approaching.

We look forward to serving your family's eye care needs, and thank you for choosing our family to care for yours.

Sincerely,

Dr. Matejka and Staff

As of January 1, 2023 we have

added the following fees:

Patients will be subject to a $40 fee if they do not give 24 hours notice of cancellation or do not show for their appointment. (15 minutes late is considered no-show.)

All new patients and all parties of 2 or more that want to schedule on same day must pay a $40 scheduling fee/deposit that will go towards copay/product when they show. Or will go toward the no-show fee.

ACCEPTED PAYMENTS

We accept Cash, Debit Card, American Express, Master Card, Visa, Discover, CareCredit and PayPal.

INSURANCE PLANS

We participate with VSP, Medicare, MES, NVA, VCP, Risk Management, Superior Vision, and OptumHealth Vision/Spectera.
Check with our staff if you have other types of coverage.