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Patient Forms

Kindly complete and return the attached paperwork prior to your upcoming appointment.  Please send all paperwork back to [email protected]. If you have any questions, please call our office at 561-451-0655.

***Note – You will also need to provide your medical insurance information. If you have any questions feel free to contact us directly. Thank you! We look forward to seeing you soon and welcoming you to our practice!


Financial Info

Mitchell Refractive Surgery & Eye Center is dedicated to helping patients across the Boca Raton, Palm Beach County, Delray Beach, and Boyton Beach area achieve great, healthy vision and skin. A part of this commitment is making treatment as affordable as possible and accommodating to our patients’ payment methods to the best of our ability. We offer multiple payment plans and several payment providers. When you visit for your free consultation, we can get you quickly and easily approved for financing as well.

Your Healthcare Credit Card

CareCredit is the credit card exclusively designed for healthcare services. CareCredit offers special financing on purchase of $200 or more* for healthcare procedures not commonly covered by insurance, including LASIK and Premium-IOLs. Why put off improving your vision tomorrow, when you can see clearer today?

Pay your post-care balance online with the CareCredit credit card.

We proudly accept the CareCredit credit card to help you finance your healthcare needs. Now you can use Pay My Provider, a new online payment solution from CareCredit, to pay outstanding balances quickly and securely. Special financing options are available.*

*Subject to credit approval. Minimum monthly payments required. Visit www.carecredit.com for details.

Credit Cards

We accept payments made by credit card through American Express, Discover, MasterCard and VISA.

Government Approved Plans

Several government-approved plans can also make treatment with our eye doctors or esthetician affordable for you.

  • 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.
  • 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 our services more affordable to you.

Get Started Today

Our Boca Raton, FL practice offers premier services in eye care and skin care. Our skilled eye doctors and entire staff look forward to welcoming you to our office. Please contact us if you have any questions.


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