Contact Lens Patient Agreement

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Advancements in contact lens technology offer the potential of successful contact lens wear to most of our patients. A contact lens is a medical device in contact with the tissues of your eye; therefore, it must fit appropriately to maintain the health of your eyes. A contact lens prescription can only be determined by the careful observation of the lens on the eye and the eye’s response to the lens on follow-up care is
essential, it is your responsibility to keep all appointments and follow all lens care instructions.


Before a person can be fit with contact lenses, a complete medical and refractive eye examination is necessary. This exam is critical to assure the good health of your eyes and to rule out the possibility of any unsuspected, underlying condition that may prevent contact lens use.


The goal of contact lens fitting is to find the most appropriate contact lens for each patient’s optimal vision and comfort. An enormous variety of types, material, sizes and colors are offered. We are committed to taking the time and effort to fit your contacts properly. Some patients will need more than one fitting session, sometimes this process requires several appointments. Everyone being fit into contacts must go through the fitting process. We will not finalize the contact lens prescription until both the individual being fit for contacts and the doctor are satisfied with the fit and visual acuity of the contact lens. We will provide one set of trial lenses. Dispensing of trial contact lenses may only be at the
time of the original examination and scheduled follow-up visits when a change is required. A contact lens trial will not be dispensed at other times. Any patient who is changing lens brands must have a new fitting and there may be an additional fitting charge. Please order your supply of contacts at least one week prior to running out of your contact lenses.


The patient will be provided with instruction concerning the safe care and usage of contact lenses. If additional time is needed, it will be necessary to schedule a second 30 minute training session at a different time. Upon completion of successful insertion and removal, the patient may begin wearing the contact lenses and a one week follow-up appointment will be scheduled.


Follow-up appointments are necessary to assure contacts are fitting and moving well, prescription is providing the best vision, eyes are remaining healthy, there is no problem with insertion and removal, patient understands and complies with the recommended wearing schedule and will not over wear and over use contacts, prescriptions will not be written for patients who do not keep follow-up appointments. There is no charge for your follow-up appointment.


By law, a contact lens prescription is valid for only one year. All patients are required to come in for an annual contact lens exam. This is necessary to assure that the patient’s eyes are healthy and the contact lenses are still fitting well. Contacts cannot be renewed without an annual exam. Contact lens exams have a separate charge that is NOT included in your medical exam and may not be a covered by your insurance.


NEW WEARER = $100.00

REFUNDS: No refunds on contact lens fitting or contacts.


I am aware of other alternatives for the correction of my vision other than contact lenses. Even with proper care there are risks to wearing contact lenses, which include:

  • SOFT CONTACTS: irritation from solutions or protein build-up, conjunctivitis, corneal in shape of the corneal vascularization and severe and potentially blinding corneal infections and loss of eye.
  • RIGID CONTACTS: Intolerance, corneal swelling and or ulceration, corneal warping, change in shape of the cornea causing problems seeing well with glasses and irritation from chipped or broken lenses.
  • EXTENDED WEAR CONTACTS (WE DO NOT RECOMMEND OVERNIGHT WEAR OF ANY CONTACT LENSES): Risks include significantly increased risk of corneal ulcer and infection and severe and potentially blinding corneal infections and loss of eye. EXTENDED WEAR DOES NOT IMPLY “CONTINUOUS WEAR.

*I acknowledge that I have been properly instructed in the care of my contact lenses. I also understand that if I do not follow the instructions given for the care of my lenses, I put myself at risk to develop infections that that can lead to the loss vision or even the loss of an eye.

*I also understand that poor care of my lenses may make them uncomfortable and not wearable and may increase the cost of my contact lens wear. I understand the fragility of contact lenses and that there is no warranty against damage of the lenses. Also, I have been instructed and have practiced insertion and removal of my lenses (if applicable).

*I understand that this contact lens prescription is valid for replacement lenses for ONE YEAR and that an annual exam and contact lenses exam will be required to update this prescription for replacement lenses after one year. I understand that if I do not have an exam after one year, then my risk of infection, discomfort or ruined lenses becomes greater as time passes.

*I understand that it is normal if at first:

  • My lenses itch or feel unusual
  • I feel one lens more at times
  • My vision seems fuzzier than with glasses
  • One eye sees better than the other

I will remove my lenses and call the office if:

  • I develop unusual pain or redness
  • I experience decreased vision that does not get better
  • I suspect something is wrong

I understand that if an eye infection, allergy, etc. occurs during a contact lens fitting the treatment of said eye infection, allergy, etc. will be billed to my medical insurance and I will be responsible for any copay under my medical insurance. I understand that full payment is expected at the times a contact lens fitting is performed.




Contact Wearing Schedule:


Wear Time
Lens Type


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1180 N. Indian Canyon W100
Palm Springs, CA 92262


Monday-Friday 8-5 (closed 12-1)
Saturday-Sunday Closed

72650 Fred Waring Drive, Suite 106
Palm Desert, CA 92262
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