Clearly Eyecare, LLC
Round Rock Hutto

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New Patient: Eye Exam
Established Patient: Eye Exam
New Patient: Eye Exam + Contact Lens Fitting
Established Patient: Eye Exam + Contact Lens Fitting
First Time Contact Lens Wear: Eye Exam + Contact Lens Fitting
Contact Lens Follow Up
Medical Office Visit
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**PLEASE NOTE:** In order to book an exam, we may request for a Credit Card to be placed on file. A $99 fee will be charged to the card only in the case of a MISSED appointment that FAILED TO NOTIFY the office ahead of time. The charge will NOT apply to appointments that need to be Cancelled/Rescheduled so long as notice is given NO LATER THAN 48 HOURS BEFORE the time of the appointment. The Credit Card information will be DELETED from file once checked-in to the appointment, and thus will NOT be used to settle outstanding balances at the end of your visit. BY CONTINUING TO BOOK AN APPOINTMENT, YOU AGREE TO THE STATED CONDITIONS ABOVE.

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**PLEASE NOTE:** In order to book an exam, we may request for a Credit Card to be placed on file. A $99 fee will be charged to the card only in the case of a MISSED appointment that FAILED TO NOTIFY the office ahead of time. The charge will NOT apply to appointments that need to be Cancelled/Rescheduled so long as notice is given NO LATER THAN 48 HOURS BEFORE the time of the appointment. The Credit Card information will be DELETED from file once checked-in to the appointment, and thus will NOT be used to settle outstanding balances at the end of your visit. BY CONTINUING TO BOOK AN APPOINTMENT, YOU AGREE TO THE STATED CONDITIONS ABOVE.

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Notice

Due to a high number of no-shows, we now require a credit card to secure your appointment. If you miss your appointment or cancel with less than 48 hours’ notice, your card will be charged a fee. Online bookings are not finalized until a staff member contacts you to collect your credit card information, or you may call us directly to provide it. Thank you for your understanding and support.

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Private Pay
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Notice

Private Pay
By checking this box, you are choosing to be a private pay patient.