Contact Lens Agreement

Contact Lens Agreement

Contact Us

Dr. Kurtbay Optometry

750 Irving Street

San Francisco, CA 94122

(Phone) 415-759-5448

(Fax) 415-759-9399 


The initial step in achieving successful contact lens treatment is a yearly comprehensive eye examination. This permits the doctors to thoroughly evaluate the health of your eyes and to provide a prescription for glasses. Once the prescription for glasses is confirmed, the doctors will determine if you are a good candidate for contact lenses. This will involve a contact lens fitting evaluation. If you qualify as a candidate, the doctors will go through a diagnostic evaluation. This procedure will be composed of acquiring the exact shape of your eyes, assessing the health and structure, and fitting the contacts that best suits your eyes. 


  FOR PATIENTS WITH VISION INSURANCE   : Contact lens exam evaluations and fittings are generally not covered and require additional fees. Most vision insurances usually cover a general examination every year. The contact lens evaluation is separate from the general examination and the fees have been determined according to the level of care and number of office visits necessary to monitor the health of your eyes. 


The follow-ups are necessary for evaluating your eye health and ability to adapt to the lenses. These office visits are especially important for you to become a successful contact lens wearer. Most patients are able to wear contact lenses successfully; however, a successful outcome cannot be guaranteed. 


1)  Contact lens examination and fitting fees are based upon the level of difficulty and time spent with patient. These fees range from $98-$189. If necessary, contact lens patients include 2 follow-up visits within a period of 60 days from the original date of exam.


2) Each additional visit after the 2nd follow-up and/or past 60 days from the original date of exam will incur an additional $49 per office visit. These visits are the responsibility of the patient. 


3)   Contact lens prescriptions are only valid for one year from the date of original exam and can only be released after the contact lens examination and fitting have been completed, the patient is wearing the contact lenses successfully, and all transactions are completed.



  Return Policy   : Returns or exchanges will be accepted 30 days from purchase. Opened, damaged, or marked boxes of contacts are not valid for return. Credit only. No refunds.


  Professional fees for the eye examination, contact lens evaluation, and training are non-refundable.


Patients who are new to contact lenses are required to have a contact lens training with our office to enable them with the latest methods of insertion, removal, and contact lens care.  


  INFORMED CONSENT AND COMPLIANCE AGREEMENT   :

  Contact lenses are medical devices that require professional supervision in order for successful wear. Possible side effects and adverse reactions, including eye infections or corneal ulceration, have been explained to me. There is an increased risk for infection when contact lenses are worn overnight compared to a daily wear schedule. No drops of any kind are to be used except those prescribed by the doctor. If either eye becomes red or irritated, the lenses are to be removed and then consulted with the doctor. Dr. Kurtbay and/or associates reserve the right to terminate this agreement upon non-compliance by the patient to prescribed wearing schedules. Contact lenses purchased elsewhere will be the responsibility of the patient. I have had the opportunity to ask Dr. Kurtbay and/or associates questions and have received acceptable answers.

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