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Patient Information and Forms

We care about your personal and medical information. Please review the Notice about how your information is used and disclosed, and how you can get access to this information.

We ask all our new patients to fill out the forms below before their first appointment. Simply click on the links below, print the forms and fill them out before your first visit to Miramar.

Note: You will need Adobe Acrobat Reader to view these forms. If you do not have Adobe Acrobat Reader, you may download it by clicking on the icon below.

Insurance & Financing

Miramar Eye Specialists Medical Group accepts many insurance plans. If you do not see your plan listed, please call 805-648-3085 to see if we accept your plan.

PPO & Vision Plans:

  • AETNA
  • BLUE CROSS
  • BLUE SHIELD
  • CHOICE CARE (HUMANA)
  • CIGNA/CONNECTICUT GENERAL LIFE/GREAT WEST
  • COMPBENEFITS
  • COVENTRY (CCN/FIRST HEALTH)
  • EYEMED
  • FOUNDATIONS FOR MEDICAL CARE
  • GALAXY
  • HEALTH SERVICE GROUP OF CALIFORNIA
  • HEALTHNET
  • MEDI-CAL
  • MEDICARE
  • MES (Medical Eye Services)
  • MULTIPLAN/PHCS/BEECH STREET
  • RAILROAD MEDICARE
  • SPECTERA
  • SUPERIOR
  • TRI-WEST
  • U.S. DEPT. OF LABOR
  • UNITED HEALTHCARE/PACIFICARE
  • V.C.H.C.P.
  • V.C.H.O.
  • VSP (No Healthy Family VSP Plans Accepted)

Miramar Eye Specialists Medical Group is now offering financing through Citi Health. Approval for financing will be processed through surgery schedulers as the financing will be for surgery procedures only. We are offering the following programs:

6-month payment plan - no interest  minimum $750
48-month payment plan - 12.96% interest  minimum $1,250

Additionally, surgeries that are scheduled at Miramar Eye Specialists Medical Group will have the ASC fees financed as well. For more information, refer to surgery scheduler or Elizabeth.

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