Contact Lens Information Fees for your contact lenses are comprised of three components: Comprehensive vision and eye examination (This includes your Eyewear Rx) Contact Lens professional services (There is an additional fee for this service, it includes your Contact Lens Rx) Patient Initials. I understand that there is an additional fee for Contact Lens professional services, this fee applies even if there is no change in the contact lens Rx or material. Contact Lens materials Contact Lens professional services include: Special anatomical and optical analysis related to contact lenses Initial contact lens design development Ordering, verifying and dispensing diagnostic lenses Complete instruction on proper insertion, removal, and care of lenses All contact lens follow-up care for three months The fees for contact lens professional services vary depending upon the complexity of the case and previous contact lens experience of the patient. Where should I purchase my lens materials?We know that in today’s market, consumers have more options than ever as to where to purchase contact lens materials.We are all bombarded daily with advertisements that imply savings of up to 50% off. We believe that Family VisionCenter has some of the best pricing available. In addition, when you purchase your one-year supply of lenses from us youreceive our exclusive extended service program. This includes, but is not limited to: Complimentary emergency lenses.Complimentary replacement of torn or damaged disposable lenses.Complimentary exchange of unused packages of disposable lenses, should your prescription change during the first six months following your exam.Sixty day performance warranty on all non-disposable materials.Free shipping within the United States of all lens materials.30% discount on prescription or non prescription sunglasses. Consent(Required) I understand that there is an additional fee for Contact Lens professional services, this fee applies even if there is no change in the contact lens Rx or material. The fee varies depending on the type of contact lens. Fees generally vary from $75.00 to $217.50. Some fees may be covered by your insurance. Specialty lens fittings are available for an additional fee.Name First Last SignatureDate MM slash DD slash YYYY