Patient Forms
No Surprise Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of expected charges for medical items and services. For further information, please download the form below.
Patient Referral
Looking to refer a patient to Somerset Ophthalmology? Simply fill out the downloadable form and fax back to our office at (248) 822-7008, and our office staff will contact the patient directly.
Health Information Authorization
If you need a copy of your medical records or would like to have outside records sent to Somerset Ophthalmology, please fill out the attached form in its entirety.
Emergencies
Same day emergency appointments are available if you have an eye emergency.
In case of a life-threatening emergency, please call 911. A serious eye emergency is best treated in the emergency room at the hospital. Please go directly to Beaumont Hospital-Troy or Royal Oak or Ascension Providence Rochester Hospital-Rochester.
Appointments & Cancellations
We try to honor your scheduled appointment because we value your time. Please understand that medical emergencies do occur and when these circumstances do occur, we do ask for your consideration. If you are unable to keep an appointment, we ask that you kindly provide a 24-hour notice be given to the office.
After Hours Care
The office has an after-hours emergency answering service that can assist you during non-business hours. The phone number is 855-444-9750.