•患者在安装期内必须返回所有计划的随访。•不遵守其后续时间表和/或不返回诊断镜头的患者将缴纳额外费用。RGP/特色装备费刚性气体可渗透（RGP）特色隐形眼镜$ 175 _______ mini scleral/Corneal/Corneal/Corneal重塑/医学上必要的接触镜头$ 500 _______我承认我已经阅读了此文档，我已经阅读了此文件，了解隐形眼镜的好处和风险，并同意当前的建议。我也了解我有权在配件比赛中收到我的隐形眼镜处方副本，并将为我提供一份。Patient or Guardian__________________________________________________________________Date________________________ Decline of Fitting: __________________________________________________________ Date________________________ (by signing here, I understand that I will not receive a contact lens prescription)