Book Appointment With - Clearly Eyecare, LLC

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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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A hold of will be placed on your card. You will only be charged if you miss your appointment.