What is the reason for this visit?

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Please enter your personal information

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Additional Notes

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Please Enter your Insurance Information

BlueCrossBlueShield, United Healthcare, Priority Health, Aetna, etc

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Enter your vision insurance if any

Review and Submit

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Cancelation / No Show Policy: We require a minimum of 24 hours notice for any changes to your appointment. Late cancellations, late rescheduling, or not showing up to any scheduled appointment will incur a $65 fee to the card you provide prior to scheduling.
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  • 2. Appointment details
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