Online Bill Pay
Click on the link below to make a payment online
We ask our patients to complete these forms before their appointment. Please click on the link below, print the forms and fill them out before coming for your first visit.
If you need to update just one or two of the forms, click the one(s) you need below:
- Refraction Notification
- Authorization To Share Patient Information
- Speed Questionnaire--Prescott PV only
- Patient Registration
- Hippa Consent
- Financial Responsibility Policy
- Patient Medical History
Glasses are made-to-order products and are not returnable. We will work with you until you are satisfied with your glasses. Just return to any of our locations and our friendly opticians will be happy to help you with any issues you’re having with your glasses up to 90 days from the date you’ve received them.
Contacts may be returned within 60 days of receipt as long as the outer box has not been opened. This is due to hygienic and safety issues and is a requirement of the contact lens manufacturers. Specialty contact lenses, such as those for keratoconus, are not returnable.
Terms of Service
We highly value the trust you have placed in us by sharing your financial, personal, and medical information with us. Kokopelli Eye Institute is a covered entity under HIPAA and any information regarding medical records, including optical prescriptions, is covered by that law. We never share your information with a third party except as allowed under HIPAA regulations, such as your insurance company and other health care providers at the patient’s direction. We do not keep any financial information except for reoccurring charges under our payment plans with explicit customer permission and we would never sell your information to any third party under any circumstances. We endeavor to keep all of your information secure at all times and take the trust you’ve placed in us seriously. If you have any questions about HIPAA or any other questions regarding your information, please feel free to email firstname.lastname@example.org
On occasion, you may need us to ship your order to you. We will be happy to do this via UPS ground or 2 day express. If you need this service, please ask your optician. We will give you the cost of the shipping per UPS at that time. The charge for you will be exactly what UPS charges us.