Crystal Vision Clinic Appointment Scheduler

Crystal Vision Clinic
Appointment Scheduler

How can we help you today?

All fields are required

Did you purchase your glasses here?

Describe the issue:

Do you have a current (non expired) prescription for glasses?

Please Enter Your Medical Insurance.

Step 1 Do you have any medical insurance

We ask for medical insurance in case anything medical comes up in the exam,
you will be asked for vision plan (Eyemed or VSP) information on the next screen.

Do you have insurance

Where is your insurance from

Why do we need this information?
The claims go to different places depending on that info, we want to make sure your claim gets sent to the appropriate site so we don't get a claim denial that could result in you owing for your exam

Choose your medical insurance plan

Who is the primary insured party?

Please Enter Your Vision Plan Information

Medical insurances typically outsource vision to a group such as VSP, Eyemed, Spectera, Superior, etc.

Do you have a vision plan?

Enter your vision insurance if any

Who is the primary insured party?

Please enter your personal information

All fields are required

Male Female

Are you an existing patient?

Do you wear contact lenses?

Please select a provider.

What is the reason for this visit?

Please choose one

Please select a date and time

space available

Review and Submit

Please review then click submit.

Cancellation Policy / No Show Policy for Eye Examinations
We value your business and ask that you respect our business scheduling policies. Please notify us at least 24 hours in advance of any cancellation. Any cancellations with less than 24 hours or notice or No Shows are subject to a cancellation fee of $100.00.

1. Personal Details
- First Name:
- Last Name:
- Dob:
- Email:
- Phone:
2. Appointment details
- Reason for visit:
- Appointment time:
- Provider: