Dilated eye exam
As a part of your comprehensive eye exam, your eyes will be dilated. If you choose NOT to be dilated you may defer by initialing and letting the doctor and staff know. You can choose to be rescheduled for the dilation portion of the exam on a day of your convenience.
Financial Responsibility - Medical Information Release - HIPPA
The above information is true to the best of my knowledge. I authorize my insurance benefits be paid directly to the physician. I understand I am financially responsible for any balance. I authorize Maui Optometry or insurance companies to release any information required to process claims. I also acknowledge that I have been given notification of my HIPM privacy rights.