Since VRT is a personalized therapy tailored for your vision deficit and adjusted every month by our NovaVision clinicians, we require a prescription and a visual field examination test from your doctor. You can obtain these from an optometrist, ophthalmologist or neuro-ophthalmologist, if you don’t currently have a doctor you can find one near you on our Physician Directory or let us help you find one.
The following information will outline the process and forms that must be filled out by you and your physician before commencing VRT and NeuroEyeCoach.
You may have received either by email or mail or downloaded through our Resources page a packet of information about our therapies which also include the following patient forms:
This form must be given to your doctor before you take the visual field test. There are three sections on this form, the first one is VRT Inclusion Criteria: It includes necessary information that will help us identify whether you are a candidate for VRT.
The second section is Therapy Optimization: On this section, your doctor will ask you for information related to your visual deficit, your health, living situation and your computer experience.
The last section is the Prescription: This section gathers your personal information and the doctors practice information as well.
This form should also be given to your doctor together with the Candidate Information and Prescription Form.
The information gathered from the Eye Examination Form and the Visual Field Test will assist our NovaVision clinicians to prepare and interpret your therapy regimen.
The HIPAA Release form must be signed and filled out by you (Patient or Legal Guardian). The Health Insurance Portability and Accountability Act (HIPAA) is a US law designed to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers.
The Patient Agreement recognizes your need to know about the therapies, payment and other important information before committing to our therapies.
Once our clinician has gone through all of your completed forms and your visual field test and determined that you are a suitable candidate for VRT and NeuroEyeCoach, you will then need to submit the Payment Form and fax it through our HIPAA Secure Line at 561.620.2546.
If you have created an account through our NovaVision Portal, you can conveniently upload all your forms with the exception of the payment form. Our Clinicians will automatically be notified every time a form is uploaded, alternatively, they can also be faxed to our HIPAA Secure Line at 561.620.2546.
If you have any additional questions you can reach our Patient Services team at 561.558.2000 or Toll Free at 888.205.0800 or email us at firstname.lastname@example.org