Patient Center/Online Forms

Patient Center

At Hartland Eye Care , we believe in continual improvement of our services. Please take a few moments and share your experience with our office. We appreciate your feedback!

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Online Forms

Speed up your visit by completing the necessary form(s) below. For your convenience, you can either fill the form(s) out online or download and print the form(s) and bring it with you to your appointment.

New Patient Adult Form - Submit Online | Download & Print

Required for All Patients Over 18 Years of Age

New Patient Youth Functional History Form - Submit Online | Download & Print

Required for All Patients From 5-18 Years of Age

Advanced Wellness Screening form - Download & Print

There are two tests that can detect glaucoma very early. If you want to be certain that you don't have early glaucoma you can choose to have these tests.

There is another test (Eye Q) that determines the density of macular pigment. This is a great way to determine if you are getting the proper level of nutrition.

TBI (Traumatic Brain Injury) History Form - Download & Print

30 Point Quality of Life Survey - Download & Print

     Should be filled out if the patient has had any history of learning problems such as:

    • ADD/ADHD
    • Dyslexia
    • Special education services
    • Reading delays
    • Excessive time spent with homework
    • Reading ability not consistent with their ability in other areas
    • A learning problem requiring the services of tutors in or outside school
Payment Options

Hartland Eye Care believes in the value of eye care for you and your family. We have products and pricing to accommodate all budgets. Our office participates in most insurance programs. For patients who have little or no vision insurance coverage, flexible payment programs can be arranged. To learn more about our payment options, please call our office directly.

Our office accepts cash, check and all major debit and credit cards including MasterCard, Visa, Discover, Care Credit and Flex Spending.

Don't forget to use your:

  • Flexible Spending Plans
  • Health Savings Accounts (HSA)
  • Medical Savings Accounts (MSA)
  • Cafeteria Plans for most of your eye care needs

All of the above plans can be used for all your eye care and eyewear needs, including eyeglasses, contact lenses, routine office visits and medical office visits.

Insurance

Since there are so many plans and coverage varies widely, please call us to find out if your plan covers care in our office. Our staff will verify and explain your benefits before your visit, at no charge. Most insurance plans are accepted, including, but not limited to:

  • Aetna
  • Always Care
  • Blue Cross Blue Shield
  • Davis Vision
  • Delta Vision
  • EyeMed Vision Care
  • Heritage Vision
  • MEBS
  • MECA
  • MRCC
  • NVA
  • VSP
No Insurance

For patients who have little or no vision insurance coverage, flexible payment programs can be arranged. If you have no insurance or do not have vision benefits there is still a way for you to receive the care you need. To learn more about our payment options, please call our office directly.

Care Credit

Many patients choose to put medical expenses on Care Credit to make purchases fit in their monthly budget. Our staff can help you through the easy process of applying for Care Credit.
Learn more about Care Credit.