New and existing patient forms & resources

Kelly Eye Center Financial Policy

We accept MasterCard, Visa, and Discover credit cards, ATM debit cards, and personal checks. A $25 fee will be charged for each returned check. You will be responsible for your co-pay, co-insurance or deductible at the time of services. Any questions regarding insurance should be directed to our insurance coordinator. We are currently in network with most major insurance companies. If your insurance company is not listed above, please call our office at (919) 282-1100 to confirm that we participate with your plan.

The handbook that was provided by your insurance company will include detailed information about what is covered (or not covered) by your policy.  Our staff will assist you in determining if your services will be covered by your insurance. Most policies require patients to pay a portion of their health care costs as an “out-of-pocket” expense. We are obligated, by contract, to collect co-payments, co-insurance and deductibles. In most cases, we will request that you pay your out-of-pocket expenses on the day that services are performed.

New Patient Forms

New Patient Paperwork – English

New Patient Paperwork – Spanish

General Information

Cataract and Astigmatism Handout


Existing Patient Forms

Medical Records Release Form

Additional Contact Information

  • Surgery Scheduling: 919-282-1117
  • Optical Shop: 919-282-1118
  • Billing: 919-282-1114
  • Physician Liaison: 919-282-1115

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