Patient Center

Online Forms

Welcome to our patient center! Drs. Kime, Kopan and Associates offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

This lets us know the history and current state of your health. Please complete the following form prior to your visit. This information is needed to establish your chart and will guide your doctor in addressing any significant issues you may have during your visit.

Patient Information and Health History Registration Form - Submit Online

HIPAA Privacy Policy - Download & Print

Office Brochure - Download & Print

Release of Medical Records Authorization Form - Download & Print

Patient Satisfaction Survey - Submit Online

Payment Options

Drs. Kime, Kopan and Associates believes in the value of eye care for you and your family. We have products and pricing to accommodate all budgets. Our office fees are based on the professional skill, knowledge and service provided by our doctors. Payment is expected at the time services are rendered. A fifty percent deposit is required prior to ordering glasses or contact lenses, and the balance is due when you receive your new eyewear. We gladly accept VISA, MasterCard, Discover, and American Express.

Don't forget to use your:

  • Flexible Spending Plans
  • Health Savings Accounts (HSA)
  • Medical Savings Accounts (MSA)
  • Cafeteria Plans for most of your eye care needs

All of the above plans can be used for all your eye care and eyewear needs, including eyeglasses, contact lenses, routine office visits and medical office visits.

In most cases, we will bill your vision or health insurance carrier as payment. Since all insurance plans are different, it is your responsibility to check with your insurance carrier before your appointment to determine if your policy will cover the visit. If your insurance company requires that you pay a co-payment, this amount is expected to be paid at the time of service. Please bring your current insurance card with you. Our staff members have experience working with many different plans and would be happy to assist you with any insurance questions you may have.

No Insurance
If you do not have insurance coverage or if we are not providers for your plan, you will be expected to pay for your services in full at the time of your visit or make payment arrangements prior to your appointment. If you have no insurance or do not have vision benefits there is still a way for you to receive the care you need. To learn more about our payment options, please call our office directly.