2312 North Rosemont Boulevard Suite #103, Tucson, AZ 85712
Focused solutions for your family's sight and success.

Patient Center

Patient Center Forms

Because we like to spend as much time as possible with your during your exam, we would appreciate it if you could please fill out these forms completely before your arrival.

All new patients:

Authorization To Release Info

HIPAA and Insurance Form

Visual Skills Questionnaire (Not Brain Injury)

Vision Report Card

New brain injury patients:

Brain Injury Vision Questionnaire



Comprehensive Eye Exams (Annual Eye Exams)

We take vision insurance plans for Comprehensive Eye Exams only. Please contact us directly to confirm that we accept your insurance.

Orthoptic Therapy (Vision Therapy)

Arizona Vision Therapy Center does not participate with any medical insurance plans for Orthoptic Therapy (vision therapy). We feel that our time is best spent focused on our patients’ care and wellbeing than on the endless red tape required by many insurance plans. However, we will provide you with the correct forms to file with your medical insurance company to receive reimbursement..

While Optometric vision therapy is not inexpensive, it should be seen as an investment in you or your child’s future.

Payment Plans

Realizing that the cost of vision therapy may be a financial burden for some families, we offer a variety of different payment plans that can help meet your financial needs.


Arizona Vision Therapy Center has made special arrangements with CareCredit. Please do not hesitate to discuss this with our front office staff. We are more than happy to assist you in any way. If you have any further questions, please call the office at (520) 886-8800.

Our caring and highly-trained vision experts are here to help.


We thank you for the concern you are showing your patient / student. We would like to make it easy for you to refer them to us. See our referral form below.

Referral Form