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Premier Vision Clinic, Dr. Jennifer DenHartog, Optometric Physician

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Call 515-512-1444
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Patient Resources

Forms

If you want to fill out our forms online, continue here.

You can also download the PDF and/or Microsoft Word documents below, print them out, fill them in, and bring them at your upcoming visit.

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Please bring to your appointment:

  • Past records if you are a new patient
  • Wear your contact lenses to the appointment
  • Past contact lens Rx or a copy of your prescription if you are a new patient
  • All glasses to the appointment; everyday, computer, piano/music, reading, etc
  • List of current medications

What To Expect

  • Please provide all insurance information, both medical and vision, when you schedule your appointment so that our insurance department can determine your eligibility and benefits prior to your exam.
  • Please arrive 10 minutes prior to your appointment time to check-in.   
  • We recommend you allow up to 90 minutes for your exam to allow for dilation as well as a contact lens evaluation and/or frame and lens selection.  You may arrive prior to your exam to choose frames which may expedite your time spent in the office.  

Not sure what your benefits cover? Read "Understanding Your Benefits" by clicking here.

We offer Retinal Imaging as well as Dilation as part of our comprehensive examination.

  • Clarus Retinal Imaging is a photograph of up to 200 degrees, or approximately 80%, of the retina in the back of the eye.  This imaging can be done either with or without dilation.  The imaging allows a view of the retina to screen for signs of macular degeneration, diabetes, glaucoma, and overall retinal health, even in the absence of dilation,
  • Optovue iWellness Imaging allows the doctor to see beneath the surface of the retina, where signs of disease may first appear.  Specifically, a detailed screening of the macula may help to diagnose early warning signs of macular degeneration and other macular changes, as well as glaucoma.  The doctor recommends this test for patients with family history and for patients over 50 years of age. 

This combination of Digital Retinal Imaging also provides a permanent and historical record of changes in the eye. Images can be compared side-by-side, year after year, to discover even subtle changes and help monitor health.

  • Dilation provides an additional view for the doctor, which is highly recommended if any previous diagnosis has been made, or if you are being monitored for cataracts.

Our doctor strongly recommends both retinal imaging as well as dilation to have the most comprehensive view.  In the event you are unable to be dilated, Clarus Retinal Imaging allows a screening of the retina, and the doctor will further recommend Dilation if necessary.  

Retinal imaging is covered by some insurance plans with a $39 copay, or out of pocket for a $39 fee.

  • Do you know how your medical insurance & vision plans work together? What do they exactly cover? Learn about your benefits here.
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