top of page

Visual Skills Exam Form
(Part 1)

Please fill out Part 1 and Part 2 to complete your paperwork. If you have any questions please call us at 520-886-8800.

  • Instagram
  • Facebook

VSE Form

Patient Information

Birthday
Month
Day
Year

Appointment Type

Single choice
Visual Skills Exam
Sensory Learning Program Exam
Neurofeedback Exam
Other

Medicare Part B

I understand Arizona Vision Therapy Center has opted out of Medicare and Medicare reimbursement is not available.
Yes
No
Call and schedule an appointment today!
Phone: 520-886-8800

​

Fax: 520-886-8805

  • Instagram
  • Facebook

2312 N Rosemont Blvd

#100 & #103

 Tucson, AZ 85712

AVTC Logo

T: 9:00am-5:00pm (Closed for lunch 1:00pm-2:00pm)

W: 9:00am-5:00pm (Closed for lunch 1:00pm-2:00pm)

Th: 9:00am-5:00pm (Closed for lunch 1:00pm-2:00pm)

F: 9:00am-5:00pm (Closed for lunch 1:00pm-2:00pm)

S: 8:00am-2:00pm

bottom of page