Office Forms



If you are scheduled for Visual Skills Evaluation or Low Vision Evaluation, the following forms can be printed, completed and brought with you.


  • For Vision Therapy or Visual Skills Evaluation (VSE):

           VSE History Form and Child or Adult Visual Efficiency Checklist


Medical Release Forms to print, fill out and fax :



We accept plans with the following most popular insurance carriers:  Allegiance, Cigna, BC/BS, Medicaid, HELP, Medicare, New West, and VSP. If your particular insurance is not listed, please contact our office and we will let you know if we are preferred providers for your insurance.


In the event that your insurance does not have a vision plan, or we are not preferred providers, you do have other options. 


You may still choose to see us; pay for your services and we will help you submit forms for reimbursement.

You also may be able to utilize our Quality Vision Care Plan that provides a discount for services and materials such as glasses and contacts. You would then submit for reimbursement through your insurance company. 


We also accept Care Credit as well as Visa, Mastercard, American Express and Discover.


Employment Opportunities:


If you would like to work at Quality Vision Care, please call us 449-3937 to pick up an application or send us your resume. We look forward to meeting you!