Patient Resources
Patient Forms
Pajka Eye Center Patient Forms
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- Pajka Eye Center Patient Registration Sheet
- Pajka Eye Center Medical History Forms
- Pajka Eye Center HIPAA Omnibus Notice of Privacy Practices
- Pajka Eye Center Acknowledgement of Receipt of Notice of Privacy Practices
- Pajka Eye Center Access to Protected Health Information Request Form
- Pajka Eye Center Medical Information Release Form (HIPAA)
- Pajka Eye Center Notice of Nondiscrimination
- No Surprises Act
- Pajka Eye Center Request for Medical Records Form
Eye Surgery Center of Western Ohio Patient Forms
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- Eye Surgery Center of Western Ohio HIPAA Omnibus Notice of Privacy Practices
- Eye Surgery Center of Western Ohio Patient Access to Protected Health Information Policy and Forms
- Eye Surgery Center of Western Ohio Advanced Directives, Physician Ownership & Patient’s Bill of Rights
- Eye Surgery Center of Western Ohio Notice of Nondiscrimination
- No Surprises Act
Financing
Pajka Eye Center Financing Plan
Our care and cost of laser vision (LASIK,PRK) is comprehensive. It includes a comprehensive occular examination, corneal mapping, pachymetry, the procedure itself, laser facility fee, any enhancements and post-operative care for 2 years. We know that everyone has different needs when it comes to financing, and we are glad to help you to arrange an individual and flexible plan that best suits your budget and needs. We currently have low monthly payment plans. We accept cash, Mastercard, VISA, Discover, or a money order for your procedure.
Potential Financial Benefits to Laser Vision Correction
Laser Vision Correction is tax deductible if you itemize. Please check with your tax expert for all of the details on this matter. In addition, Medical Spending accounts, such as Flex credit or cafeteria plan, may allow you to set aside pre-tax dollars and pay a portion of your Laser surgery!
Learn More
For more details, call Julie Bassitt, Director of Marketing & Refractive Services at
419-228-7432 or Toll Free: 800-568-2020
Contact our office to learn more about our procedures or to make an appointment.
