Patient Forms & Policies

Patient Forms

You may submit your information through our online patient forms or printable patient forms and bring them to your appointment.

We require intake forms to be completed before your appointment is scheduled to begin. Your scheduled exam time does not include time for forms to be completed, so please arrive early to complete them if necessary. Thank you!

Online Patient Forms

Click here to complete your intake forms online. You need to complete three tabs and the Submit Data tab:
1. Demographics tab
2. Age-appropriate intake tab
3. One of the services tabs – Neuro, Vision Therapy or Low Vision

The LAST STEP is to click on the Submit Data tab and click the SUBMIT DATA button.

You cannot save your information and return at a later time, so please allow at least 15 minutes to complete and submit your information in one session.

Printable Patient Forms

Please select two of the PDF forms below and bring them completed to your appointment.

1 – Child History Intake or Adult History Intake
2 – Vision Therapy Intake, Neuro-Optometry Intake, or Low Vision Rehab Intake

Returning Patients

If you have been seen in our office before, please call us at (913) 469-8686 and we’ll give you a passcode to update your information online.

Patient Portal (For current patients only)

Insurance & Professional Fees

We currently accept the following insurance:

• BlueCross BlueShield Plans (Except BCBS Select and Advantage Plans)
• Original Medicare & Your Supplemental Insurance (Except “managed” Medicare plans such as United, Aetna, and the like)
• Workers’ Compensation Insurance Plans

If you are Out-of-Network with insurance participation, fees are expected at the time of service or when materials are ordered. We accept all major credit cards, checks and cash. We can provide you with the an insurance form to self-submit a claim for reimbursement. 

Payment plans are available for vision therapy programs and special-order glasses and devices. 

Before Your Appointment

For All Patients

• We require 24 hours advance notice to cancel or reschedule appointments. Please see our cancellation policy for more details.
• Please bring your completed history forms and a list of current medications. Otherwise, please arrive early to fill them out.
• If you wear glasses or contacts, please bring them with you.
• BlueCross BlueShield and Medicare patients need to bring their insurance and Supplement cards.
• If we don’t participate in your insurance policy, please be prepared to pay for services on the date of your appointment. We are happy to help you self submit a claim. Please ask us for assistance.

Vision Therapy Patients

• If you are bringing your child for testing, please be prepared to stay and observe. A separate report consultation will be scheduled on a separate date at the end of the evaluation.
• Adult patients typically have testing and the results on the day of the appointment.

Neuro-Optometry Patients

• Please make sure we have records from referring physicians or therapists before your appointment date.

Low Vision Rehab Patients

• Bring your recent glasses prescriptions and any magnification devices you are currently using.
• Plan for your visit to last up to two hours. If possible, please have a spouse, relative, or friend accompany you to your appointment. It’s great to have a second set of ears during your evaluation.
• Your evaluation will include a clinical low vision exam with Dr. Metzger followed by an evaluation with a Certified Low Vision Therapist

Cancellation Policy

Our vision care is characterized as low volume with high quality, and we schedule our appointments to ensure maximum care for all patients. Each and every appointment space is important, and as a courtesy to all, we do not overbook to compensate for those who do not honor their appointments.

To cancel or reschedule an appointment, please call (913) 469-8686. Messages left on the answering machine will be logged at the time they were recorded.

Our appointment cancellation policy is necessary to maintain the high professional standards of our practice. Missed or cancelled appointment spaces deprive other patients of treatment, disrupt our efficiency, and cause financial difficulty for the office. Our policy is as follows:

Cancel your appointment at least 24 hours prior to your appointment time — No charge

No call or message to cancel your appointment within 24 hours of your appointment time — $75 charge to your account

Rescheduling more than two times (cancelling an appointment twice) — We require a credit card on file and will apply a $100 charge for future cancellations or rescheduled appointments

You will be responsible for this charge because it cannot be billed to your insurance company. Future appointments will not be made until the cancellation fee is paid. If a patient accumulates a total of 3 missed appointments, future appointments will not be scheduled.

These policies have been enacted to improve all patients’ experience in our office. Please let us know if you have any questions regarding this appointment policy so that our staff may clarify for you. Thank you for entrusting us with your vision care.