Patient Forms & Payment Information

Patient Forms

To save yourself time when checking in at your appointment, you may access the following forms via this website. Please download, print and complete the following forms, and bring them to your appointment. You will also need to provide your medical insurance information. If you need any assistance with filling out the forms, our staff is happy to help you the day of your appointment.

New Patient Forms


adobe *These forms require Adobe Acrobat Reader. Click the Adobe logo above to download.


Payment Options

You Can Afford LASIK Vision Correction!
Mitchell Refractive Surgery & Eye Center is dedicated to making LASIK corrective surgeries more affordable. We offer multiple payment plans and several payment providers. We accept payments made by: case, American Express, Discover, MasterCard and VISA credit cards.

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Now every patient with the desire to see without the need for glasses or contact lenses has three times the opportunity to qualify for financing! When you visit for your free consultation, we can get you quickly and easily approved for financing.

Several government-approved plans can also make LASIK vision correction affordable for you.

  1. Flexible Spending Accounts (FSA) allow you to deduct any tax-exempt amount you choose from each paycheck for non-covered healthcare costs at any time during the year.
  2. Health Spending Accounts (HSA) are also tax-exempt and have been compared to IRA accounts, in that you can use it for healthcare or retirement. Unlike FSA's, you can use your Health Spending Account like an investment program.

Consult your Human Resources Department to learn whether your company offers either of these beneficial programs. Both are perfect opportunities to make LASIK and medspa services more affordable.