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0 www.northtorontoeyecare.com Fax: (416) 748-8582 | Phone: (416) 748-2020 | Email: [email protected] Ocular GTA NW (Main Office) 2065 Finch Ave West, Suite #400 M3N 1W8 Physicians & Central GTA (Surgical Center) 2 Champagne Drive, Unit C2 M3J 2C5 Surgeons North York 7 Elmwood Ave M2N 6R6 PLEASE CIRCLE: Please complete contact and patient information. URGENCY: □ Same Day □ ASAP □ Routine □ Follow Up T. Rabinovitch PLEASE INFORM PATIENT TO BRING CURRENT LIST OF MEDICATIONS, EYE DROPS & Cataract Surgery PLEASE ADVISE PATIENT OF TWO POSSIBLE APPOINTMENTS (PRELIMINARY TESTING & DOCTOR EXAMINATION) Refractive Surgery Cornea & Uveitis Last Name: ________________ First Name: ________ DOB (Y/M/D): First Name: _______________________________________ Phone #: ____________________ Address:_ J. Waisberg OHIP: _ Version Code:Version Ophthalmology Referring Doctor: Dr. Dry Eye Disease Cosmetic Botox Address: Postal Code: T Fax: Tel: _____ _________ REFRACTIVE SURGERY M. Azadeh GLAUCOMA High IOP Lasik/PRK Consult CATARACTS PRIVATE OHIP Cataract Surgery Ophthalmology Disc Cupping RLE/CLE Premium Lens VF Field Loss ICL TRIFOCAL/EDOF Narrow Angles FEMTO Cataract Surgery CORNEA Keratoconus/CXL SLT/LPI N. Pesin _______________________________________ PCO (laser on site) (Performed on site) Keratitis Cataract Surgery________________ OD OS OU Ophthalmology Corneal Ulcer OCULOPLASTICS AMD DRY WET Pterygium Chalazion/Lesions/Cyst INFLAMMATORY Hole/T ear/Detachment Blepharoplasty DISEASE RETINA Conjunctivitis T. Hess ERM Ocular Rosacea Oculoplastics Diabetic Retinopathy Episcleritis/Scleritis Cataract Surgery Ptosis Macular Edema Uveitis/Iritis Entropion/Ectropion Choroidal Nevus Cellulitis Punctoplasty Retinopexy/Focal/Barrier TESTING /PRP Laser (on site) Visual Field/OCT BOTOX V. Lam Blepharospasm Uveitis, Cataract & DRY EYE MTO Hemifacial Spasm Cornea Surgery Tear Film Analysis Pentacam Topography Hyperhidrosis Lipiflow/IPL OD OS OU Cosmetic/Fillers Tearing/Blocked Duct T. Le OD OS Cataract Surgery Ophthalmology BCVA Paediatric IOP REFRACTION G. Yau Additional Information: Medical Retina Cataract Surgery NO PREFERENCE For EMERGENCIES please contact 416-748-7116 or 416-748-2020 ext. 0 Please feel free to fill out a referral form on our website at www.northtorontoeyecare.com Please direct your patients to our patient education videos available on our website .

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Icare Eye Hospital Rate List 2015
ICARE EYE HOSPITAL & POST GRADUATE INSTITUTE E-3A, Sector – 26, Noida – 201301 Tel:- 0120-2477600 / 02, Counselor: 0120-2477621 Fax: 0120-2556389 / Appointments: 9811880015 Email: [email protected] / Web: www.icarehospital.org ICARE EYE HOSPITAL RATE LIST 2015 S No. PARTICULAR TARIFF (₹) I CONSULTATION NEW PATIENT VALID FOR 7 DAYS (FIRST TIME CONSULTATION : REGISTRATION + 1 ₹ 600/- CONSULTATION) 2 REVIEW CONSULTATION VALID FOR 7 DAYS ₹ 500/- 3 EMERGENCY CONSULTATION FOR 7 DAYS ₹ 800/- 4 LOW VISUAL AIDS ASSESSMENT CHARGES ₹ 600/- 5 VISION THERAPY CHARGES FOR PER SITTING ₹ 200/- 6 COST OF VISION THERAPY SOFTWARE (CD) ₹ 6,000/- 7 AMBLYOPIA (CD) ₹ 4,000/- II INVESTIGATIONS 1 Digital F.F.A (Fundus Fluoroscein Angiography)(Inclusive of Fundus photo) ₹ 2,500/- 2 Colour Fundus Photo - Digital ₹ 600/- 3 Colour Slit-lamp photo ₹ 600/- 4 Duplicate color prints (FFA/OCT/CLINICAL PHOTO) ₹ 300/- 5 Orthoptic ₹ 250/- 6 OCT (Optical Coherence Tomography) ₹ 2,500/- A Repeat OCT (within 2 months) with printout ₹ 800/- B Anterior Segment OCT ₹ 2,500/- 7 Ultrasonography (U/S) A A Scan – Single Eye ₹ 600/- B B Scan – Single Eye ₹ 1,000/- C UBM - Single Eye ₹ 1,500/- 8 Computerized field analysis A Humphrey Visual Fields (HVF) both eyes ₹ 1,500/- B Humphrey Visual Fields (HVF) One eye ₹ 750/- 9 Diurnal Variation of Tension (Day DVT ) A 5 times tension (Done in both eyes)] ₹ 500/- Page 1 10 Pachymetry (Both eyes) A Ultrasound (Central Corneal Thickness- CST) ₹ 600/- B Optical ₹ 600/- 11 Corneal Topography A Single Eye ₹ 1,000/- B Both Eyes ₹ 2,000/- 12
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Cataract Surgery
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