Services
Enter each copay or charge, or check Fully covered by insurance. Unused services stay off the receipt. Use the extra row or Add Service for anything else.
ServiceCharge / Copay
Miscellaneous
Eye drops, eye masks, cleaning supplies, vitamins, and other items.
Checkout Summary
Contact LensesAdd the completed quote to Today's Charges when ready.
Vision TherapyAdd the completed VT charges when ready.
Itemized Receipt
Total to Collect Today$0.00