Contact Lenses Policy & Service Agreement Contact lenses are medical devices regulated by the Food and Drug Administration. California law requires that patients receive a contact lens fitting by a licensed eye doctor every year.Please initial here that you have read and understand the FDA fitting requirement.*A contact lens exam involves additional procedures and additional time with the doctor and thus an additional fee. The fee will vary depending upon your prescription and the type of contact lenses that are right for you. Fitting fees range from $90 for disposables up to $325 for specialty rigid gas permeable lenses. Insurance companies recognize this as a separate service and so it has a separate procedure code and benefit.Please initial here that you have read and understand the contact lens exam fee*Our contact lens fitting commitment to you includes the following:A 90 day fitting period and any trial contact lenses necessary to obtain well fitting lenses during the 90 day period.The fitting must be completed within the 90 day period, otherwise a new charge may be incurred.If custom contact lenses are ordered for you, you must pay for them at the time you pick them up. They are exchangeable within the 90 day period to obtain the proper fit. There are no refunds or exchanges after the 90 day period.Contact lens training for new wearers and a contact lens starter cleaning kit.Six months of follow up care from the date of your contact lens exam. This includes a six month follow up visit as well as any office visits due to contact lens related complications during the six month period.A copy of your contact lens prescription will be presented to you when the fitting process is complete.Our prices are pretty competitive. Sometimes our prices are even lower than box stores and online vendors. If you find a lower price, simply print it out and we will do our best to match a price along with the use of rebates.Convenience. We stock many Acuvue lenses for your convenience so you don't have to make an extra trip to pick them up. Order an annual supply of contacts and we will ship them to you for free.If you purchase your contact lenses from our clinic, it comes with our guarantee that you can exchange any boxes, opened or not, for any reason.Please initial here that you have read and understand our contact lens commitment.*Patient's commitment: By signing below, I agree to abide by the contact lens fitting policy as stated above.*Date* Date Format: MM slash DD slash YYYY Check One*PatientParentLegal GuardianNameThis field is for validation purposes and should be left unchanged.