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 Evaluation $55-75 w/no Ins. (Depending upon the type of contacts needed)

Click here for a listed document of the accepted insurances of Repko Family Vision.


Patient Information

Privacy Policy

PP/iWellness/Retna Agreement

Patient Forms

Patient Information Form

Medical Information Form

Insurance Agreement Form

If the Patient is a Minor (Under 18)

Minor Form

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