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Dr. John Metzger, Low Vision and Vision Rehabilitation OptometristSpecialized Low Vision Care and Rehabilitation offers hope to those with vision loss.
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Low Vision Patient Referral Form

At this time, Dr. Metzger is seeing low vision patients on the following days.
Low vision evaluations typically take about 2 hours.

Thursdays, 8 a.m. to 6 p.m.
Fridays, 8 a.m. to 6 p.m.
Saturdays, 8 a.m. to 2 p.m. (Summer hours may vary)
Type of low vision rehabilitation care requested: * Consult and render opinion only.
Low vision evaluation and ongoing low vision care.
Other
Patients Name (First/Last): *
Diagnosis:
Patients Insurance: * Medicare
Medi-Gap
Medicaid
No insurance
Patients Phone:
Preferred appointment day/time
Caregiver Name (First/Last):
Caregiver Phone:
Referring Physician:
Office Location:
Patient complains of: Decreased distance acuity
Difficulty with reading
Difficulty with glasses (3 Rx changes)
Known V.F. loss
Permanent loss of acuity from 20/50 or worse
Photophobic or glare problems
Diplopia or ghost images
Unusual body-neck-head posture
Vision flashes on and off
Things jump into field of vision
Unresolved visual complaints
Post stroke, head injury or or other neuro event
Other
Comments:
Tech/Staff Name: *
E-mail Address: *
Tech/Staff Phone: *
* Required
 
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  John Metzger, OD
913-469-8686
11248 Strang Line Rd., Lenexa, KS 66215
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