Exam Plus Explanation and Consent We are committed to providing our patients a medical eye examination. For VSP/Kaiser the benefit provided is a basic eyeglass exam. It does not cover some medical testing that we feel are important in providing comprehensive medical eye care. If you have an HMO or are using your eyeglass benefit such as VSP/Kaiser we want to provide you with the same level of medical care as we provide our PPO and Medicare patients. EXAM PLUS INCLUDES TESTING FOR corneal disease - specular microscopy retinal disease - retinal imaging surface disease - topography refraction and glasses – wavefront testing & prescribing neurological disease – rapdx, hypertension – blood pressure The Exam Plus fee is $68.50. “If you are going to spend any money on eye care please use it to sign on for exam plus. This battery of tests gives us the diagnostic tools that are fundamental to good medical care. It truly is our priority.” Dr. Evans. I wish to proceed with Exam Plus I wish to decline Exam Plus Signature