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New OrthoK pt agreement
Parent Name
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The first year fee of $2500 includes the following: - Initial consultation, fitting and evaluation of custom lenses - All lens changes made by the doctor within the first 12 months - Unlimited follow-ups; typically includes approximately 6-8 visits - Final pair of lenses, plus a spare pair of lenses, if no lenses were lost or broken - All topography, evaluation of contact lenses, and vision testing - All training on insertion and removal of lenses - All necessary communications necessary between parent/patient and staff/Doctor - Behavioral coaching through emails/messages that help parent & patient implement natural behavioral changes needed to support myopia management at home After the first year of treatment, there is $350 per year cost that includes: - Myopia Care follow up appointments (2-4 visits) - Topography, evaluation of contact lenses, and vision testing as needed - Any additional training & learning - Behavioral coaching messages to support natural changes of behavior in the home - Myopia Management with Ortho-Keratology should be continued until a child has reached 18-20 years of age in order to be the most effective. - This program fee is for the 2nd year of the program and occurs annually thereafter. In order to ensure the healthy fit and best vision of your child's lenses, it is important to keep up with these visits. If you exceed the 12-month period, the fee will be 10% higher. What is not covered by the program fee? - This program fee does NOT include a new pair of lenses if the lenses need to be replaced in Year 2 or later. Lenses range from $600-$800 per pair. - Annual routine exam (this may be billed to vision or medical insurance if applicable). - Any medical care during this period will be treated separately and your medical insurance rules will apply. If rare circumstances prevent you from continuing your treatment during the first three months of care, we will gladly refund all fees paid, less $250.00