• Auburn Westborough Eye Assc. Ultrawide vs Dilation Waiver And Hippa Waiver

  • To provide the highest level of care, our doctors strongly recommend that all patients have a thorough examination of their retina. We recommend all new patients have a baseline dilated exam either at the time of their exam or return to the clinic within 6months of their initial exam to be routinely dilated. This appointment will be covered under the first exam. We recommend most individuals age 15+ be dilated every 2 years, and individuals over the age of 40 be dilated every year if indicated.

    Our office is now pleased to offer the latest in cutting edge technology that provides a 200 degree high resolution image of the retina. We can view up to 90% of the entire retina without the eyes being dilated with the new ultrawide retinal camera. The retinal ultrawide photograph is $39.00 and is NOT covered by insurance for routine eye care.

    If pathology or a medical diagnosis is documented with this testing, the photographs will be billed to your medical insurance as part of your treatment plan and the $39.00 out-of-pocket charge would be waived. If a medical diagnosis is found, you may be asked to have your eyes dilated either the same day or at a later day and the routine eye exam may become a medical exam
  • MM slash DD slash YYYY
  • NOTICE OF PRIVACY ACT, HIPPA

    I acknowledge that I received or reviewed a copy of Auburn Westboro Eye Associates “NOTICE OF PRIVACY ACT, HIPPA” policy found posted at the office or on the website auburnwestboroeye.com
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.