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Practice Name

Samantha Slotnick OD, FAAO, FCOVD

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Primary Location
495 Central Park Ave, Ste 301
Scarsdale, NY 10583
Phone: 914-874-1177

Office Hours

DayOpenClosed
Monday10 am6 pm
Tuesday10 am6 pm
Wednesday10 am6 pm
ThursdayClosedClosed
Friday10 am6 pm
SaturdayBy Appt.By Appt
SundayClosedClosed
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Registration - Adult Patient

Adult patients, please use this form to register prior to your first appointment. Our patient care coordinator will contact you shortly.

Patient Date of Birth:

Address:

ALL INSURANCE CARDS AND VISION COVERAGE MUST BE PRESENTED BEFORE SERVICES ARE RENDERED. PROOF OF MEDICAL INSURANCE DOES NOT GUARANTEE PAYMENT BY THE INSURANCE COMPANY. PLEASE BE AWARE THAT:

1) MEDICAL INSURANCE DOES NOT COVER NON-MEDICALLY RELATED VISION EVALUATIONS.

2) VISION PLANS DO NOT COVER NON-ROUTINE OCULAR HEALTH (MEDICAL) SERVICES.

Medical Insurance Information:

RELEASE OF INFORMATION AND INSURANCE FILING:

I request that payment of authorized insurance be made to Dr. Samantha Slotnick for any services rendered. I authorize any holder of medical information about me, to release to HCF and its agents any information needed to determine these benefits payable for related services. I also understand there may be procedures that are not covered by my insurance and I am responsible for payment, including but not limited to refraction. I understand that payment in full is expected when services are rendered and materials dispensed.

HIPAA privacy acknowledgement - I was given and read, and understand my privacy rights under the HIPAA laws. (Copy available in Patient Forms area.)

Let's Meet!

Meet Dr. Slotnick and learn about signs of Vision Problems, FREE!

Call to reserve a space for yourself and a guest at our NEXT Workshop: 

914-874-1177

Leave your email and # below, and we'll be in touch with you soon!

Name: *
Email: *
Phone: *


 

Extended Interview:
En "Vision" Your World

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Online Forms

Samantha Slotnick OD, FAAO, FCOVD offers our patient form(s) online so they can be completed in the convenience of your own home or office.
Download Online Forms Here

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We will do our best to accommodate your busy schedule. Request an appointment today!

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Services

We strive to provide complete care for our patients. Learn more about all the services we provide.

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Contact

Samantha Slotnick OD, FAAO, FCOVD
495 Central Park Ave, Ste 301
Scarsdale, NY 10583
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Administrative Office Hours

DayOpenClosed
Monday10 am6 pm
Tuesday10 am6 pm
Wednesday10 am6 pm
ThursdayClosedClosed
Friday10 am6 pm
SaturdayBy Appt.By Appt
SundayClosedClosed
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