Georgia Mountain Ophthalmology, Dr. Matthew Camp, M.D., Retina Specialist, Jasper, Georgia, Your First Choice for Medical Eye Examinations.
To save time during your appointment, print out these
forms, fill them out and bring them with you.
Patient Forms
Appointment Scheduling

We value your time as much as we do our own and make every
effort to adhere to scheduled appointment times. Schedule
your appointment as far ahead of time as possible. You may call
our office to schedule your appointment or you can go to our
online contact page to request a non-urgent appointment. We
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Georgia Mountain Ophthalmology, Matthew W. Camp, MD, Your First Choice for Medical Eye Examinations
Records Release Authorization
Please fill out this form if we need to request your records
from another physician.
request 24-hours notice if you need to cancel your appointment. We are aware that
unforeseen events sometimes require missing an appointment, but to allow us to better care
for all of our patients we must be able to depend on your timely arrival. After missing an
appointment without notifying us 24 hours in advance, you are subject to being charged a fee.


Financial

Please understand that payment is expected as services are rendered. To make this as easy
as possible, we accept most medical insurance plans as well as most major credit cards. If
necessary, we can make special payment arrangements prior to treatment. We will submit  
insurance claims for you to plans in which we participate and we will assist as much as we
reasonably can to help you receive full insurance benefits; however, you are personally
responsible for your account and we encourage you to contact us if your policy has not paid
within 30 days. In order to prevent any misunderstanding please take a moment to read our
Financial Policy.


Insurance Plan Participants

We want you to get all of the benefits you are eligible for from your health insurance
coverage.  Many health insurance plans require a referral from your primary care physician
prior to consultation with a specialist.  In addition, some plans also require preauthorization
before any type of surgical procedure or laser treatment. It is your responsibility to obtain the
required referral from your primary care physician.  Failure to obtain a referral or
preauthorization, if required, will result in your health insurance denying payment for our
services.  In this case, you will be held financially responsible for all services obtained
through our office. If you are uncertain whether your health insurance requires a referral or
preauthorization, please call your health insurance’s customer service representative or
your primary care physician’s office for more details.
150 Interstate South Drive
Suite 200
Jasper, Georgia 30143

telephone 706-253-2267
fax 678-454-7331
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