Patient Info


Patient Appointment Information

Patient InformationUpon arrival, our staff will invite you to register. All new patients will be asked to complete a New Patient Registration Form and a Medical History Questionnaire. We will need to see your valid insurance cards and photo ID to set up insurance filing. Established patients will be asked to verify current demographic, medical and insurance information. Accurate records help us to serve you more efficiently and file your claims correctly. Click below to download the forms you will need. You may print them off and bring your completed forms to our office to expedite the check-in process.

What To Bring To Your Appointment

  • New Patient Registration Packet (PDF) – Completed
  • Photo ID
  • Glasses and contact lenses with packaging. Wear lenses if you have them.
  • Current Insurance Cards
  • ALL required referrals must be in our office prior to your appointment
  • Co-pays are due at the time of appointment
  • Acceptable form of payment – Cash, Check, Visa, Mastercard, Discover

Other Forms

Insurance & Billing

Medical Plans

Nashville Vision Associates is a Medicare participating practice accepting assignment on all covered medical and surgical procedures. Patients are responsible for:

  • deductibles
  • co-insurance
  • co-payments (for a specialist)
  • refractions
  • contact lens fittings/evaluations for renewing prescriptions
  • contact lenses
  • any non-covered services

Patients participating with Health Spring or other HMO insurance companies must obtain a referral from their primary care physician prior to their office visit. Those referrals can be faxed from the primary care physician directly to our office at (615) 915-5091 or (615) 915-5074. It is the patient’s responsibility to verify insurance benefits prior to their appointment. Refer to the back of your insurance card for customer service help.

Vision Plans

Call your insurance company proir to your appointment to find out if your provider is on that plan. NASHVILLE VISION ASSOCIATES DOES NOT PARTICIPATE IN ANY VISION PLANS AS A GROUP. ONLY Drs. Jerkins and Bounds participate with the EYEMED & VisionBlue plans