2312 North Rosemont Boulevard Suite #103, Tucson, AZ 85712
Improving Your Outlook on Life!

Patient Forms

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 the appropriate forms completely before your arrival.

For a Visual Skills Exam (no history of brain injury) (for visual symptoms or vision-related learning problems):

Patient Forms (crystalpm.com)

For a Visual Skills Exam (history of brain injury) (for those with trauma, mold exposure, toxin exposure, or who have had a stroke):

Patient Forms (crystalpm.com)


Arizona Vision Therapy Center does not participate with any medical insurance plans. 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 necessary invoices to file with your medical insurance company to receive reimbursement.

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.

Empowerment Scholarship Account (ESA)

This is an account administered by the Arizona Department of Education and gives eligible parents public funding to pursue flexible options for customizing their children’s education. It is intended to expand educational opportunity outside of the public school system and provides public funding for a wide range of personalized education expenses, including private school tuition, tutoring services, textbooks and more. Qualified applicants must be on an Individualized Education Plan (IEP) and not be enrolled in a Public School (Private or Home Schoolers are eligible).  The application link is http://www.azed.gov/esa


Fellow Colleagues, 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

BBOT Quick Brain Region Questionnaire