Download TruVision Retreatment Warranty

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TruVision Retreatment Warranty
The TruVision Retreatment Warranty provides you with the right to
“retreatments” after completion of your laser vision correction surgery. You are entitled
to post-surgery retreatments subject to the following conditions:
If a retreatment is required, you agree to pay a licensing fee of $110 per eye for all
lasers except the Autonomous, which charges $150 per eye. You will not pay any
additional charges to the participating doctor who performs the retreatment or for the
facility at which the retreatment is performed.
This Retreatment Warranty is not valid with any other promotion, is nontransferable and has no cash value. This Retreatment Warranty is subject to the
additional terms and conditions set forth on the reverse side of this certificate.
During each 12-month period following your initial laser vision correction
surgery, you will have an opportunity to extend this Retreatment Warranty by having a
warranty exam performed by a participating TruVision doctor. The fee for this exam is
currently set at $75.00 (Price may change without notice). The Retreatment Warranty
will become void if you do not schedule the retreatment exam through TruVision each
year following your laser vision correction surgery.
You must schedule each retreatment exam through TruVision by calling
1-877-644-2020.
ADDITIONAL TERMS AND CONDITIONS
A. If there are any taxes, fees or charges imposed by any governmental authority with
respect to the Retreatment Warranty, you will pay those taxes, fees and charges as
and when they are due.
B. The Doctor’s medical opinion is final in regards to any retreatments that may be
performed.
C. You agree to follow the doctor’s advice with respect to general eye health and care
given at any retreatment exams. Failure to follow the doctor’s advice may void this
Retreatment Warranty.
D. If any questions arise concerning the date of the retreatment exam, the records of
TruVision shall be conclusive as to when and if the laser procedure and subsequent
exams took place.
E. Upon the scheduling of the retreatment exam a non-refundable fee will be collected in
the amount of $75.00 by TruVision. The member may reschedule the appointment
with TruVision or the Doctor with a minimum notice of seventy-two hours. If a
seventy-two hour notice is not given the appointment can not be rescheduled. If the
member elects to reschedule the appointment an additional $75.00 non-refundable fee
will be required at the time of the new appointment.
F. You understand and agree that TruVision is in the business of marketing vision
correction services and is not licensed to and does not provide such services. Such
services are provided solely by a licensed physician who is a not an employee or
agent of TruVision. TruVision does not warrant, guarantee or otherwise make any
promises with respect to the outcome of any vision correction services provided by
the doctor. In the event of an adverse outcome in connection with any vision
correction services you receive pursuant to this Retreatment Warranty, you agree that
your sole and exclusive remedy is against the Facility of the vision correction services
and not, under any circumstances, against TruVision, Inc., any of its affiliates or their
respective officers, directors, agents or shareholders.
G. The Retreatment Warranty is based on current/existing excimer technology which
was used to perform your LASIK or PRK procedure.
H. The Retreatment Warranty does not cover other ocular occurrences unrelated to the
LASIK procedure, which may cause changes in the patient’s vision. These include,
but are not limited to, corneal ectasia, keratoconus, corneal opacities, lens changes
such as cataracts, increasing myopia, hyperopia and/or astigmatism.
Patient Signature __________________________________________
Date _______________________________