Please complete your intake form immediately after requesting an appointment:

Prompt completion of your form allows our staff time to update your profile, and allows the doctor time to review your information before your appointment.

If you have vision benefits you’d like to use, it’s even more important to complete your form promptly, so that we have time to verify your benefits. Sometimes, we do not have time to verify benefits at check-in, and you may be required to pay out-of-pocket and submit the claim yourself to your insurance.

INTAKE FORM

Please respect our cancellation policy:

We understand that circumstances may change, and you may need to cancel your appointment. To avoid any inconvenience, we kindly request cancellations to be made at least 24 hours in advance. Failure to cancel within this timeframe will incur a $50 service fee. Furthermore, a no-show will result in 100% of the service fees being charged.

As a small business that provides services (ie we do not sell any products), any missed appointment is an expense for us (ie we still pay our doctors and receptionists when patients don’t arrive). Our office respects your time, and we appreciate the same. Thank you for your understanding and cooperation.

If your insurance isn’t listed, likely, we do not take it. Please contact us to ask insurance questions before scheduling.


Providing eye care for the greater Seattle area (downtown Seattle, SODO, Tukwila, White Center, Capital Hill, Belltown, Northgate, Shoreline, Burien, West Seattle, Rainier Beach, Fremont, Queen Anne, Ballard, Bellevue, Mercer Island, Kirkland, Issaquah, Renton, Seatac), since 2015; including eye exams for glasses, sunglasses, contact lens exams, and office visits by our optometrists.