PATIENT FORMS

Complete Online

Click the buttons below to complete your new patient forms and submit them online. We will provide forms that require a signature at the time of your appointment.

New Patients

Returning Patients

Download and Print

Click the buttons below to download your forms. Note: be sure to save the files to you computer before entering information electronically. You can bring them to the office at the time of your appointment or email them to Beth.
View and/or Download our Notice of Privacy Practices.


Insurance Information

There are two types of health insurance that may help pay for services and products at Blink Eyecare. You may have one or both.


Vision Insurance: Vision care plans that cover only routine or healthy vision exams. They may also give discounts on materials such as glasses or contact lenses.


Medical Insurance: Medical care plans help cover other office visits (for allergies, dry eye, or eye infections) or screening for eye diseases if you have certain systemic conditions, such as diabetes or high blood pressure.

Blink Eyecare accepts most major insurance plans. Please call the office if your plan is not listed below.

Insurance plans accepted:

  • BCBS - Blue Cross Blue Shield

  • BCN - Blue Care Network
  • EyeMed - most plans


  • Heritage Vision
  • 
Medicare


  • NVA - National Vision Administrators

  • 
Priority Health

  • Spectera

  • 
Superior Vision


  • United HealthCare

  • VSP - Vision Service Plan

  • FSA - Flexible Spending Account
  • HSA - Health Savings Account

Common employers with coverage from plans we accept:

  • Domino’s Pizza
  • 
Eastern Michigan University
  • Facebook

  • Google

  • Johnson Controls
  • Northville Public Schools

  • Plymouth Canton Community Schools
  • 
Quicken Loans
  • St Joseph Mercy Health System

  • Yazaki


Schedule an appointment

Call today to schedule an appointment and fall in love with your new pair of glasses.