New Patient Forms

Before your appointment, please print and fill out the following forms: New Patient Form, Condition of Treatment, and the HIPAA Privacy. For vision-and-learning patients, please fill out the Convergence Insufficiency Symptom Survey. For brain injured patients, please fill out the Brain Injury Symptoms Survey. Please click the word to print the form, and bring it to your appointment. Alternatively, you could email the completed forms to our office, which allows Dr. Carter to review your health information prior to your scheduled appointment.

Our office is out of network with all insurance plans. Some plans do allow us to bill for the appointment, but Medicare and Medicaid do not. If you have one of these insurance plans, please click the word to print the out-of-network form, and bring the signed form to your appointment. (See the Insurance section below for more information).

If you have records from other providers that Dr. Carter needs to review, please print and fill out the Records Release Form and email, mail, or fax it to our office in advance. Dr. Carter requests that these records arrive at least 24 hours in advance of your appointment.


Dr. Carter is out-of-network with insurance plans because she requires a thorough health and developmental history, as well as an in-depth, behavioral approach to examinations, which is more time-intensive than a routine eye examination.

We require payment in full at the time of service. After the appointment, we will submit a claim to your insurance company if we are able (some insurance companies do not allow out-of-network billing). If the insurance company reimburses our office, we will pass that directly to you, either by a reimbursement check or a credit on your account.

Insurance plans do not always cover Vision Therapy. Call the number on your insurance card to determine if your plan covers vision therapy; we have a helpful Codes and Fees handout that provides the information your insurance provider may need. Please note that the insurance may ask for a diagnosis code, which Dr. Carter can provide at the initial appointment.

Payment Methods

Our office takes cash, personal checks and credit cards: Visa, Mastercard, Discover and American Express. We also offer Care Credit, which may allow patients more time to pay their balance. In addition, patients may utilize their Health Savings Accounts (HSAs) or Flex Spending Accounts (FSAs) to pay for their examinations and vision therapy.