Come to Millennium Eye Center for caring vision solutions that will enhance your life.
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Vision For Tomorrow Scholarship
Integrative Eye Care
Dry Eye Disease
Keratoconus and other Corneal Diseases
Ortho-K & Myopia Control
Pay My Bill
Insurances We Accept
Eye Exam Appointment Request Form
Optical Appointment Request Form
Patient Check-In Form
Health History for Integrative Eye Care Consult
Other Patient Forms
Patient Medical Record Request
Credit Card Authorization Form
Is the patient under 18?
The guarantor is always the patient unless the patient is an incapacitated adult or an unemancipated minor (under age 18), in which case, the guarantor is the patient's parent or legal guardian.
Credit Card or FSA/HSA Card Number
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I consent to the Credit Card Form Terms Below
Credit Card Form Terms:
I authorize Millennium Eye Center to charge the credit card indicated in this form to collect payment for services and products recieved at Millennium Eye Center. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.