Welcome To Our Office

MM slash DD slash YYYY
Patient"s Name
MM slash DD slash YYYY
PLease Select
MM slash DD slash YYYY
Relation to Patient
Features include: · Request Appointments Online · Confirm Appointments via Email · Receive Text Message Appointment Reminders · Submit Patient Satisfaction Surveys · Refer Your Friends Online
Communication Preference:
I authorize payment of my benefits directly to Advanced Eye Care Center for services rendered. I also authorize release of any medical information that may be required in determination of such benefits. I understand that some services and procedures may not be covered by my insurance carrier. Fees not paid by my insurance carrier will be my responsibility. This authorization is in effect until I choose to revoke it.
MM slash DD slash YYYY
MM slash DD slash YYYY

Follow Us

Advanced Eye Care Center

4025 W Bell Rd, Suite 10
Phoenix, AZ 85053

[email protected]
(Do not send personal health information by email.)

technological advances
We are Proud to Provide Co-Management of Lasik and Cataract Surgeries