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Date Signature 8674 Asheville Hwy Spartanburg SC 29316 Services Given Exam. Refraction. CTL Fit. Contacts Boxes. Elliott Keller Welcome To The 21st Century Dear Patient A new highly sophisticated computerized instrument now allows us to provide a more thorough medical analysis of your eye. Signature Date Member American Optometric Association HIPAA COMPLIANCE ACKNOWLEDGEMENT OF RECEIPT I acknowledge that I received a copy of Notice of Privacy Practices. The digital imaging system takes images...
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Step 1: Gather all necessary information such as your insurance policy number, contact details of your insurance provider, and any relevant documents.
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