LYNETTE KLINE, O.D.
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To fill out your forms online click the button below.
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Patient Forms


Medical History '13
File Size: 136 kb
File Type: pdf
Download File

Patient Information '13
File Size: 231 kb
File Type: pdf
Download File

Notice of Privacy Practices 9/1/13
File Size: 154 kb
File Type: pdf
Download File

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.
    For questions or more information about your right to a Good Faith Estimate, visit
    www.cms.gov/nosurprises or call 707-961-1037.
510 Cypress St., Suite A
Fort Bragg, CA 95437

Phone: 707-961-1037
Fax:  707-961-0346

E-Mail: 
​[email protected]
Office Hours
Mon    9 am - 12 pm & 1 pm - 5 pm
Tue     9 am - 12 pm & 1 pm - 5 pm
Wed    9 am - 12 pm & 1:30 pm - 5 pm
Thu     9 am - 12 pm & 1 pm - 5 pm
Closed Friday, Saturday & Sunday


Visit Our Online
Eye Store Anytime:

https://lynetteklineod.myeyestore.com/


  • Home
    • Meet Our Team
    • Location
    • Patient's Comments
  • Our Services
    • Myopia Management
    • My Eye Store
    • Technology
    • Promotions
    • Fashion Frames
  • Patient Forms
  • Things To Ponder
    • NEWS
    • All About Vision