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Locations
Eye Care
General Eye Care
MULTIFOCAL IOLs
Treating Presbyopia
Corneal Diseases
Diabetes Eye Care
Glaucoma Eye Care
Dry Eye Syndrome
Choosing an Eye Doctor
Services
Our Services
Reading Glasses Solutions
Glaucoma Treatment
Dry Eye Treatment
LASIK
Cataract Treatment
Seminars
Online Self Test
Media
The V-Blog
Focus Through the Generations
Videos
About
About
Join Us
YOUR VISION IS OUR FOCUS.
Form 2
Practice Information
Name of Practice:
*
Number of Locations:
*
Please list the address of each location:
*
Is there anything we should know about the location to convey to patients? (proper signage, easy to find, parking. etc):
How many years has your primary surgeon been practicing ophthalmology?
*
Roughly how many refractive surgeries has your primary surgeon completed?
*
Are there any employees in your office(s) that are fluent in multiple languages? If so, what languages and are they able to translate at appointments if necessary/what office(s) are they available?
*
How long is a LASIK consultation?
*
Who is the primary surgeon (if it’s a multi-surgeon practice)?
*
If it's a multi-surgeon practice, please list other refractive surgeons:
Are you currently using a third party marketing company?
*
If so, who are you using and what for?
Do you have an internal marketing team?
*
If so, please list the name and info of primary contact.
Do you offer same day LASIK?
*
Yes
No
Do you offer Refractive Lens Exchange?
*
Yes
No
Do you offer SMILE?
*
Yes
No
Do you offer KAMRA inlay?
*
Yes
No
Do you have an onsite Excimer Laser?
*
If not, where do you perform LASIK?
What is the name of your EHR/EMR system?
*
What is the name of your PM/Scheduling system?
*
Does your EHR/EMR and PM/Scheduling systems speak to each other?
*
Is your EHR/EMR cloud based or locally hosted?
*
Please provide contact information to gain access to EHR/EMR:
*
Name, Email, and Phone Number
Website
*
http://
COVID-19: Please list and explain all measures your practice is taking to ensure patient and employee safety during in-person visits:
*
Thank you!
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