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Financial Hardship Form

Advanced Beneficiary Notice

The following options are available on eyeglasses through Mobile Vision Care, Inc.

All fee’s must be paid before glasses are ordered.

$20 Tint  
$20 Scratch Resistant Coating* *Doctor Recommended
$20 U.V Ray Filter
Buy 2 ($20) options and get
the third ($20) option Free!
 
$40 Metal Frame Upgrade  
$50 Lite – N – Thin Lens*  *Doctor Recommended
$75 Transition Lens (Turns Dark Outside)  
$75  Progressive Lens (No – Line Bifocal)