PATIENT FORMS

Patient Form Center

At Legacy Vision, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax us your printed and completed forms or you may bring them during your visit.

New Patient Intake Form

Medical History Form

Hippa Authorization Form


New Patients

We Always Welcome New Patients

New patients keep our business growing, so we are always proud to offer high quality ophthalmology services to our patients.

We also know how overwhelming it can be when you go to a new eye doctor. For this reason, we will do our best to welcome you. We will do everything we can to give you a pleasant visit. We want you to feel comfortable to ask any questions you may have.

In order to have a timely first visit, we try to go over as much as possible on the phone. We will be happy to answer any questions you may have. We can discuss the reason for your visit, including whether or not you need new eyeglasses or contact lenses. You can even fill out our new patient forms prior to your visit, which can really speed up your appointment time.

At your first visit, we will go over your insurance information and talk to you about eye health. We will discuss any problems or concerns you have. If you have any questions, we will do our best to answer them before you see the doctor.

Our doctor will then perform a thorough examination to ensure your eyes are healthy. If you need a prescription, he will be happy to find the one that is perfect for you. If you are having difficulties with your eyes, we will work with you to help find you some relief. We will go over your options so that you can choose the one that is perfect for you.

If you have any questions about coming to our clinic, don’t hesitate to contact us today at (972) 208-5757


Payment Options

We are proud to accept many different forms of payment so that you are able to get the care you deserve.

We are always happy to go over the costs that will be associated with your visit. We will give you a breakdown to help you make the right decision for the health of your eyes. Then we can discuss payment options.

We are proud to work with most insurance providers so that you can get the care you need. We will be glad to figure out exactly what your insurance will pay. We will do our best to figure out your insurance so you don’t get any unexpected fees.

We participate with VSP, Medicare, Great West, Blue Cross, United Health Care, Aetna, Cigna, Humana, Tricare, Superior Vision and EyeMed. We also accept cash and most credit cards as forms of payment. Once we figure out what your insurance will and will not pay, we will work with you, so you get the care you deserve.

Another option is CareCredit. CareCredit can be used like a credit card in eye care offices. It is just another line of credit to ensure that you get the care you deserve. You can pay for your services over an extended period of time, so you don’t have to worry about how you are going to pay for the care you need. CareCredit offers many different payment plans with different payment dates and time frames. They even offer some payment plans that are interest free, which is even more helpful.

Care Credit Application

If you have any questions about our payment options or what your insurance will or will not cover, don’t hesitate to contact us today at (972) 208-5757


Flex Accounts

Don’t let the year end with money left in your account. Our staff will be happy to assist you in purchases on your Flex Spending Account.

Use your Flexible Spending Account (FSA) dollars. Remember that FSAs are a use-it or lose-it benefit. If you fail to use the money you deposited in the account before the year is over, you will forfeit those funds. FSAs can be used to pay for eye care services and treatment. We also have financing options available for patients needing an alternative to flexible spending.

Let us help you maximize all your insurance benefits through proper scheduling. Some procedures require multiple appointments and extra time for lab restorations. We have the option of starting some treatments at the end of one year and completing after the next year begins, providing you with two years coverage on one treatment. By doing this, we are able to reduce your out-of-pocket expenses.

If you anticipate vision work in the upcoming year and want to budget your health savings accounts and FSA, schedule a consultation with us and let us provide an estimate. You can budget your payroll contribution, and most FSAs will provide those funds up front at the beginning of the year, so you can start treatment sooner rather than later.


Privacy Policy

If you feel that we are not abiding by this privacy policy, you should contact us immediately via telephone at (972) 393-3937 or via email.

Notice of Privacy Practices

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