Welcome to Our Office

Name: Advanced Eye Care Center
Address: 4025 W Bell Rd, Suite 10, Phoenix, AZ, 85053, US
Telephone: 602-978-4025
Price range: $000 - $300

ADVANCED EYE CARE CENTER
Dr. George K. Johnson
Optometrist
Date
Date Format: MM slash DD slash YYYY
Patient's Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Social Security Number
Home Phone
Work
Ext
Employer
Occupation
Medical Insurance
Please select:
- PPO
- HMO
Primary Insured Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Relation to Patient
- Self
- Spouse
- Parent
- Other
Who may we thank for your referral
We invite you to participate in our online system.
Features include:
· Request Appointments Online
· Confirm Appointments via Email
· Receive Text Message Appointment Reminders
· Submit Patient Satisfaction Surveys
· Refer Your Friends Online
If OK, please initial
Communication Preference:
- Telephone
- Email
- Text
Cell
Email
ASSIGNMENT OF BENEFITS/SIGNATURE ON FILE
I authorize payment of my benefits directly to Advanced Eye Care Center for services rendered. I also authorize release of any medical information that may be required in determination of such benefits. I understand that some services and procedures may not be covered by my insurance carrier. Fees not paid by my insurance carrier will be my responsibility. This authorization is in effect until I choose to revoke it.
Signed
Date
Date Format: MM slash DD slash YYYY
I Acknowledge I have been offered/received a copy of this office’s Notice of Privacy Practice.
Signed
Date
Date Format: MM slash DD slash YYYY

Located in NW Phoenix near Bell Road & 43rd Ave.

Welcome to Our Office

ASSIGNMENT OF BENEFITS/SIGNATURE ON FILE

Follow Us

Testimonials

Advanced Eye Care Center

Important COVID-19 Notice. Please Click Here.

Located in NW Phoenix near Bell Road & 43rd Ave.

ASSIGNMENT OF BENEFITS/SIGNATURE ON FILE

Follow Us

Testimonials

My experience was fantastic!!!

Dr Johnson is so great

The staff is awesome and Dr. Johnson is wonderful!

Great eye care center!

I am so happy and very impressed.

Advanced Eye Care Center

Important COVID-19 Notice. Please Click Here.