follow us

Primary Insurance information | West Hills Vision Care

Primary Insurance information

Insurance & Privacy

Please contact our knowledgeable staff to answer any questions you may have regarding your individual plan. West Hills Vision Care accepts most insurances and for your convenience we will verify your benefits prior to your examination. Additionally, some companies offer flexible spending accounts (FSA) and health savings accounts (HSA), which can be used to pay for your glasses, contact lenses, Paragon CRT and LASIK.

Please fill out as much information as you can. All required fields are marked as *. If you prefer, you may download a blank form, fill it out, and bring it in with you to your first appointment.

  • Primary Insurance Information

  • Secondary Insurance Information

  • ACKNOWLEDGEMENT OF RECEIPT

    HIPPA

    I acknowledge that I have obtained, or reviewed, a copy of West Hills Vision Care, LLC’s notice of Privacy Practices. A copy can be obtained at the front desk or on our website
  • AUTHORIZATION TO BILL AND FINANCIAL POLICY

    By signing below, your signature authorizes West Hills Vision Care, LLC to request your insurance company to pay this office directly. If the insurance company remits direct payment you will be responsible for all charges of the services and products rendered. As a courtesy to our patients we take the time to verify your insurance benefits, but this does not guarantee payment and West Hills Vision Care, LLC will not be held responsible for unpaid insurance balances. Any unpaid balance will be transferred to the patient after 90 days, at which time the patient will have an additional 90 days to make payment. If no payment has been made after 90 days West Hills Vision Care reserves the right to involve a third party collection agency.
  • Parent signature if minor