Patient Resources

B-Town Eyecare has designed this page for the convenience of our patients, because we know your time is valuable to you. Here you can find resources such as patient forms, insurance providers, schedule an appointment, type of payments accepted and a link to our online eyecare glossary!

If you are a new or returning patient, below please select, download, print and complete our office forms before your appointment.

Forms (.pdf)
Patient Intake Form
Privacy Policy
Get Adobe Reader

Payment Options

  • Visa
  • Mastercard
  • AMEX
  • Debit
  • Cash

CareCredit for Better Vision

When to have your vision procedure should be the question, not how to pay for it. We’d like to make that decision even easier for our patients. That’s why we’re pleased to offer the CareCredit® card, North America’s leading patient payment program. CareCredit lets you begin your procedure immediately — then pay for it over time with low monthly payments that fit easily into your monthly budget. Now you don’t have to save up for years to finally get the vision you’ve always wanted. We’ll help you see clearer, sooner.

CareCredit is the credit card exclusively for healthcare services. CareCredit offers low monthly payment plans for healthcare procedures not commonly covered by insurance, including LASIK and Premium-IOLs. Don’t put off improving your vision. Get your procedure now.

For vision procedures, CareCredit offers:

  • Low minimum monthly payments
  • No up-front costs or pre-payment penalties

Learn more by visiting or contacting our office. Ready to apply? Apply online for your CareCredit card today, or we can also help you apply in the office during your visit. You’ll be seeing clearer in no time.

RevolutionEHR Patient Portal

To help you get the best eye care experience possible, we use a Patient Portal called RevolutionPHR. RevolutionPHR is a secure, online personal health record that allows your visit to be more efficient. Having this online portal also gives you better access to your own health record with information readily available at your fingertips.

Making Your Visit More Efficient
The Patient Portal is designed to streamline the process of communicating essential information between you and Dr. Bansal. When you have an upcoming eye appointment, we will ask you to complete a pre-examination interview so our team can fill in the key history items in your record before you arrive. While you will still have to complete a small portion of in-office paperwork, the online forms you fill out will help decrease your wait time and speed up your appointment.

Create Your Patient Portal Account
When you schedule an appointment with B-Town Eyecare, we will help you create your patient portal account for the first time by giving you a username and temporary password. Your credentials will be delivered in separate correspondence by phone and/or e-mail. When you schedule your appointment, we can determine which methods will work best for you.
Once you’ve logged in, you can start filling out your profile and completing any pre-examination interviews requested. If you need help with any part of this process, our experienced team can help.

Giving You Better Access to Your Health Records
When you use patient portal with our optometry office, you’ll have the ability to access to your personal data from anywhere. This means that if Dr. Bansal refers you to a specialist, or if you’re traveling or away from home, your information can go with you. The Patient Portal can allow you to access discrete pieces of your personal eye care data including:

  • Any medications prescribed by your eye doctor
  • A record of your appointments, including your upcoming visit
  • An account summary with past and present billing information
  • Your contact details, which can be easily updated

You will also be able to easily update your personal information, including your address, phone number and other contact details, without having to call us or fill out extra paperwork. All you have to do to keep your information current is log in to your profile and edit your details online. Once you’ve made a change, it will automatically be updated for your next visit.

If you have questions about Patient Portal or you need help setting up your account, call our office at 206-242-8545.

Insurance Affiliations and Resources

We will work with you and your insurance company to achieve the best utilization of your insurance coverage. We have many resources available at our disposal and as a courtesy, we will help estimate your insurance benefits. Please note that your insurance company will determine final insurance benefits after claims are processed. We are participating providers with most major insurance companies including, but not limited to, the following: