OPTOMAP Retinal Screening Tallahassee Eye Center offers our patients the optomap® Retinal Screening as part of your annual comprehensive eye examination. WHAT IS IT? The optomap® Retinal Screening: Allows the doctor to see approximately 80% of your retina (back of the eye) in one image (similar to a panoramic photograph) to confirm the health of your eye or to detect the presence of eye diseases such as macular degeneration, glaucoma, diabetic retinopathy, holes, tears, retinal detachments, ocular melanomas or many other conditions. The earlier these conditions are detected, the higher the chance of successful treatment. Will be saved in your medical file enabling your doctor to make important comparisons during your annual eye exam from year to year. May reduce the frequency at which you’ll need to be dilated. When we have the optomap® yearly, we can often dilate every 2-3 years rather than yearly. HOW MUCH DOES IT COST? Our fee for the optomap® has been reduced to only $25, and is typically not covered byinsurance plans. HOW LONG DOES IT TAKE? The optomap® takes approximately 2-3 minutes for both eyes and results are available immediately. Your eyes will not need to be dilated to perform the test. HOW OFTEN DO I NEED IT?The doctors at Tallahassee Eye Center strongly recommend that all patients have this test performed every year.MY CHOICE: I choose the optomap® Retinal Screening and understand that the $25 fee is not covered by my insurance. I decline the optomap® Retinal Screening. I understand that a wide field view of the retina is an important part of a comprehensive eye examination and I am declining the doctor’s recommendation of the optomap® Retinal Screening. Patient’s name: (please print) First Last Patient’s signature:Date MM slash DD slash YYYY