summit park eye petoskey

Patient Resources

Patient Forms

  • HIPAA Release Forms (right-click and save PDF to your computer to fill out and email or print)
  • Prescription Refill Request - Please call 231-348-3600 x106 or contact us here

Frequently Asked Questions

  • What do I need to bring to my appointment? Bring your new patient paperwork if applicable, your drivers license or photo I.D., all of your insurance cards, and your medication list.
  • Will I be dilated? If your appointment is for a Complete, Yearly, or Diabetic Exam you should plan on being dilated. 
  • Do I need a driver? If you are are being dilated it is recommended that you bring a driver. If you are having a surgical or aesthetic procedure requiring sedation you must always bring a driver. 
  • What are my financial obligations? Please see Financial Policies on this page.


We participate with Medicare, BCBS, Priority Health, Cofinity, United Healthcare, Aetna, Cigna, Consumers Mutual, McLaren Commercial and Medicare Advantage only, State of Michigan and Meridian Medicaid (by referral only), VSP and Eyemed. 

*If your insurance plan is not listed please contact our business office prior to your visit with any questions about your coverage and responsibilities.

Please note that it is your responsibility to know your insurance coverage and that you must bring your insurance cards with you to your appointment. If your current insurance information is not available at the time of registration you will be given the option to either reschedule your appointment or pay out of pocket for your services. 

Financial Policies

  • Financial Obligations
  • Refraction and Co-Pay Policy
  • Per Michigan law (Senate Bill 853 effective Sept. 30, 2014) the definition of a Spectacle Prescription are as follows:
    • A Spectacle Prescription is 'a written or electronic order by a licensee who has examined and evaluated a patient' and includes the following:
      • Indication that the prescription is for spectacles.
      • As applicable and as specified for each eye, the lens power including the spherical power, cylindrical power including axis, prism if applicable, and the power of the multifocal addition.
      • Special requirements that the omission of that would adversely affect the vision or ocular health of the patient including specific lens designs, materials, or treatments.
      • The Patient's name, the date of the examination and evaluation and the date that the prescription originated.
      • The prescribing licensee's name, address, phone number, written or electronic signature or other form of identification.
      • An expiration date of not less than 1 year from the date of the examination. 
      • *It does not include pupillary distance measurements and or progressive or lined multifocal height measurements. The eye care professional who's fitting your frames must perform these measurements since they can vary with frame choice.
      • *As part of our service to our patients our professional opticians perform these services for all of our patients to assure maximum spectacle fit and quality and is included in the frame purchase.
      • *If you wish us to assist you with pupillary distance measurements (P.D.'s) in order for you to purchase or acquire spectacles elsewhere we assess a $20.00 measuring fee. Progressive or lined multifocal segment height still must be measured by the person fitting your frames since is different for every frame. 
      • Summit Park Optical assumes no responsibility for the verification of prescription, fit, quality, routine repair or maintenance, adjustments, or non-satisfaction remakes for any glasses not sold or dispensed on site. Fitting and adjustment of new glasses not purchased on site are subject to an additional $20.00 fitting fee. 
  • Contact Lens Policy
  • All Specialty Contact Lenses including Gas Permeable lenses require a 50% refundable deposit or paid insurance co-pay on the day of dispense. 

Patient Bill of Rights

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