Welcome to our Online Patient Center! Here you can get information about what to expect during your visit with Dr. Dominguez and Dr. Bromley as well as important forms you can complete before your appointment to save time.
We want your visit to be as stress-free as possible. Our staff will do everything we can to make sure your experience is pleasant and convenient. If you have any questions about these forms, please don’t hesitate to contact us.
What to Expect
When you visit our office, you will be warmly welcomed and we can answer any questions you may have about completing the paperwork so that Moon Valley Eyecare may see you. Our team will work together to evaluate your eyes and provide relevant eye care treatment information, review your vision benefits and payment options, fit you for glasses or contact lenses, and focus on exceeding all of your expectations. If at any time you have questions about the process or your specific health information, please ask.
Please download and fill out each of the following forms. HIPAA Notice of Privacy Practices is required
New Patient Form - EnglishDownload & Print
New Patient Form - SpanishDownload & Print
Existing Patient Form - EnglishDownload & Print
HIPAA FormDownload & Print
Frame and Lens WarrantyDownload & Print
Moon Valley Eyecare believes in providing the best value for you and your family. We have products and pricing that aims to accommodate all budgets and our office participates in most insurance programs. For patients who have little or no vision insurance coverage, flexible payment programs may be arranged. To learn more about our payment options, please call our office directly.
Our office accepts cash, check, and major debit and credit cards including MasterCard and Visa, as well as Care Credit.
Don’t forget to use your:
- Flexible Spending Plans
- Health Savings Accounts (HSA)
- Medical Savings Accounts (MSA)
- Cafeteria Plans for most of your eye care needs
All of the above plans can be used for all your eye care and eyewear needs, including eyeglasses, contact lenses, routine office visits and medical office visits.
The Care Credit card is available to help people pay for health care expenses, often with an introductory period that is interest-free. We accept Care Credit for all of our services. To learn more or apply for the card, visit Care Credit here.
Since there are so many plans and coverage varies widely, please call us to find out if your plan covers care in our office. Our staff will verify and explain your benefits before your visit at no charge.