Repko Family Vision Center
Call us: 276-690-2345 for Gate City, Virginia
or  276-321-7039 for Wise, Virginia
HomeAbout UsGate CityWiseInsurance & Forms

​Insurances We Accept

Self-Pay Price
Glasses Exam $89.00 w/no Ins. (Includes: Prescription, pressure check for glaucoma, dilation is included if wanted and checking for any other eye health diseases.)
CL Exam $55-75 w/no Ins. (Depending upon the type of contacts needed)

Below you will find a list of Important forms which may be downloaded and printed at your convenience.  

Patient Information

Patient Forms

If the Patient is A Minor (Under 18)

All forms must be signed by patient 
(Over 18) or Parent/Legal Guardian prior to patient
 being seen.

Thank you!