San Antonio LASIKSan Antonio LASIK Logo
(210) 585-2020 icon phone call Book Vision Evaluation

OD Notes

Patient Name(Required)
YYYY dash MM dash DD
Drop files here or
Max. file size: 150 MB.
    Terms of Use(Required)
    Communications through our website or via email are not encrypted and are not necessarily secure. Use of the Internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use. The top priority of Refractive Surgery & Diagnostic Center, P.L.L.C., NuVision Same Day Procedure Center LLC, and Dr. Gregory Parkhurst (collectively “PNV”) and you ("Referring Doctor") is to optimize patient care, not to provide revenue for PNV or for Referring Doctor or for anyone else. PNV’s and Referring Doctor’s true customer is the patient, not PNV or the Referring Doctor. Referring Doctor acknowledges and agrees that all Referring Doctor’s referrals are based on Referring Doctor’s best medical judgment, rather than on any potential for financial gain. PNV acknowledges and agrees that the decision to accept referrals from Referring Doctor is based on PNV’s best medical judgment, rather than on any potential for financial gain. Referring Doctor acknowledges and agrees that PNV has never paid nor offered Referring Doctor any remuneration or anything of value in any form or manner whatsoever for the purpose of inducing Referring Doctor to refer a patient to PNV. Referring Doctor acknowledges and agrees that Referring Doctor has never had any written or unwritten agreements or understandings to co-manage patients with PNV. PNV does not provide routine or automatic co-management of patients with Referring Doctor as a fait accompli. PNV does not promise or guarantee that referred patients will go back to Referring Doctor for post-op care. Referred patients may receive their post-surgical care from PNV or from Referring Doctor or from another eye doctor as determined on a case-by-case basis exclusively for the health, convenience, and preference of the individual patient. Referring Doctor acknowledges and agrees that Referring Doctor has not upsold and will not upsell any patients referred to PNV to receive premium IOL’s (as opposed to standard IOL’s) or to receive laser treatments in conjunction with cataract surgery. Referring Doctor affirmatively represents that all referrals that Referring Doctor has made or will make to PNV are in full compliance with the Antikickback Statute (42 U.S.C. § 1320a-7b(b)) and the Stark Laws (42 U.S.C. §1395nn, §1396b(s) and 42 C.F.R. §§411.350 - .389) and all other laws, rules, and regulations, and PNV is relying on this representation to the extent that it chooses to accept referrals from Referring Doctor.
    san antonio lasik