For New 4D Vision Gym Members


Thank you for choosing 4D Vision Gym and Dr. Juanita Collier for your Vision Therapy needs.
Please know that our staff will do all we can to meet your expectations for quality patient care. We value the trust you have placed in us.

Be sure to read the info on the following pages, as well:

Before Your First Visit

We need new members to complete our 4D intake form.

Because 4D Vision Gym provides Vision Therapy services to members of all ages, please click the appropriate button here to be taken to our online intake form. You will need to give yourself about 30 minutes to supply the necessary information.

It is important that this form be completed at least 24 hours before your appointment.

We Need Your Commitment

Vision Therapy is an extremely effective method of correcting vision problems. Its efficacy is based primarily on patient compliance and consistency. As a result, it is very important to limit the amount of cancellations and inconsistencies for the duration of your therapy program.

Each of our Vision Therapy patients is assigned a specific appointment that is continuous throughout their program. Patients are asked to commit to their assigned time slot throughout the duration of therapy.

Your First Visit at 4D

4D Vision Gym is an experience.

4D Vision Gym, as its name implies, is beyond what is expected, and surpasses what is already known about vision and general Optometric offices.

Upon walking through the doors, the patient and families immediately realize that this is not your average eye doctor’s office. Our patients are not referred to as patients, but as “Members” of the gym. This immediately removes the stigma that something is wrong with the person receiving care.

You can help our office run more smoothly by arriving 15 minutes prior to your scheduled appointment.

Please bring to your appointment:

Complete insurance information, including insurance cards. 4D participates with Anthem, Aetna, and United Health Care insurances. We are out-of-network with Cigna.

Current medications.

Any pertinent medical information.

Bringing in all medications prescribed by all providers (as well as over-the-counter medicine and herbal supplements) helps us provide you with the best care.

If your health plan requires a co-payment, we will collect it during registration at our front desk.

Late Patients

Patients are considered late if they don’t arrive by their appointment time. We cannot always accommodate you and may have to reschedule your appointment.

Missed Appointments

We strive to fulfill our patients’ needs with appointment availability to the best of our ability. We will call and remind you of your appointment 1 week prior to the day and time. Please call us back within 48 hours of the confirmation call to confirm your appointment. We reserve the right to offer the appointment time to someone on our waiting list if your appointment is not confirmed.

Our cancelation policy requires a notice of 3 business days for any canceled or rescheduled appointments with Dr. Collier. If this notice is not given there will be a $75 cancellation fee.

As stated previously, Vision Therapy is an extremely effective method of correcting vision problems, and tts efficacy is based primarily on patient compliance and consistency.

In the best interest of your success at 4D Vision Gym, it is imperative to make up your missed Vision Therapy sessions in order to receive the full benefit of your time here. In our commitment to excellence in patient care, any missed or canceled appointments not rescheduled will be subject to a $40 fee. If you are unable to make your appointment and wish to reschedule to another time, we ask for a 24-hour cancellation notice or 1 business day.

Please contact the office at (860) 632-UC4D (8243) to let us know of this cancellation.

As a courtesy to patients on our waiting list, we reserve the right to discontinue the therapy program of those patients who cancel 3 appointments. We understand that situations sometimes arise, and we welcome patients back to the program when their schedule can accommodate this commitment. These patients will, however, be put on the waiting list.

Your cooperation will help us in operating in an effective manner and creating a consistent schedule that will be beneficial to all of our members.

Payment Policy

Payment is expected at the time service is rendered. Your insurance company requires you to pay your co-pay, at the time of service.

If you request to receive a bill, we will add an additional $5 for billing charges to offset billing costs.

There is a $30.00 charge for all returned checks.

Patient Rights Responsibilities