Applies to the examination of previously prescribed soft and rigid
contact lenses and renews your prescription.
$45
INITIAL
Soft Contact Lenses
•
•
•
Applies to patients being fit with soft contact lenses for the first
time or current contact lens wearers requiring a change into a
different soft lens. $150
Applies to current patients changing between spherical and toric
contact lenses. $75
Applies to current patients changing into daily contact lenses for
the first time. $55
INITIAL
Rigid Gas Permeable Contact Lenses
•
Applies to patient’s first fitting with rigid gas permeable contact
lenses or patients requiring a change into a different rigid
material or design. RGP Lenses not included.
$150
The above fitting fee includes:
Initial Fitting Appointment
Diagnostic Lenses Used (excludes RGP)
Care & Handling Instruction -- New Wearers
3 Contact Check Appointments
Patients have 3 months to follow up with their contact check
appointment(s). After that, any additional appointments may be subject to
a new fitting charge. Due to the nature of custom contact fitting services
and time invested, refunds are not considered. Once contacts have been
supplied or purchased, there are no exchanges.
Payment Policy:
Contacts are to be paid in full at the time of service. The exception
would be if your insurance covers any part of the cost. After the
insurance portion has been paid, the remaining balance must be paid in
full.
By signing below, I agree to the contact lens fitting fees that I have
initialed above. I understand that if I am using Medicare or any other
commercial medical insurance that does not cover this service, I will be
responsible for these fees.
Signature of Patient or Patient's Legal Representative
Date
655 Medical Center Dr. NE
Salem, Oregon 97301
503.581.5287
Fax 503.386.1377
mceyeclinic.com
MARCUS A. EAST, M.D.
ADAM T. SHUPE, O.D.
RYAN W. LAPOUR, M.D.
PATRICK KWONG, O.D.
CONTACT LENS WEARING PROCEDURE
Congratulations! You are taking your new contact lenses home today. We
would like to remind you of a few things that we discussed today at your
appointment.
1
Always remember to wash your hands before handling your contact
lenses.
2
Start your wearing time at 4–6 hours the first day and continue to 6-8
the second day. Remember to give your eyes a rest from contacts now
and then. Weekends or evenings are a good time to wear your glasses
and let the eyes have full oxygen exposure. Try not to over wear your
contacts.
3
Cleaning your contacts nightly is important. Not only does it keep
your eyes healthy, it lets you enjoy comfortable lenses daily. It also
gives you the wearing time that was intended for your brand of
contacts.
4
It is always a good idea to put lenses on after your face is clean.
Any lotions, shaving cream or makeup, should be done after you put
your lenses in. This will help to make sure no residue is left on your
hands. Soft lenses will absorb things like hair spray, perfumes and
lotions, to name a few.
5
Any time you notice a lens is damaged by a tear or a little piece is
missing,
DO NOT WEAR IT.
Throw it out and start with a fresh lens.
6
If a lens ever feels uncomfortable, scratchy or the eye(s) feel
irritated remove the lens and check to see if the lens is inside out.
Look for a chip or tear in the lens. If the lens is not damaged, try
the lens on again. If it is still uncomfortable, remove the lens and
leave it out. Call the office and schedule a contact check appointment
with a lens specialist if the eye(s) do not feel better.
7
Any time you have a concern or question, please call our office.
We are always glad to help you. 503–581-5287.
8
Remember, your prescription is valid for one (1) year.
By signing below, I have read and understand the contact lens wearing
procedure listed above.
