OPHTHALMOLOGY BOARD CERTIFIED EYE SURGEONS DANIEL W. WELCH, M.D. CATARACT / LASER SPECIALIST DAVID M. LOEWY, M.D. CATARACT / LASER SPECIALIST LASIK SPECIALIST NEIL J. OKUN, M.D. RETINA SPECIALIST DAMON E. WELCH, M.D. CATARACT / LASER SPECIALIST LASIK SPECIALIST ALY R. SHERALY, M.D. CATARACT / LASER SPECIALIST GLAUCOMA SPECIALIST OPTOMETRY BOARD CERTIFIED EDWARD J. ATTAWAY, O.D. VALERIE L. MOULDS, O.D. TERRANCE W. HAFNER, O.D. DAVID N. BURRY, O.D. WILLIAM J. CORKINS, O.D. JULIA R. KING, O.D. KELLY MCLAIN, O.D. TINCY THOMAS, O.D. THOMAS HEGLAND, O.D. STUART HARRELL, O.D. DANIEL SMITH, O.D. CATHERINE BORGESON, O.D. OFFICES 407 AVENUE K. S.E. WINTER HAVEN, FL 33880 863/294-3504 OR 863/293-4114 100 PATTERSON ROAD US HWY 27, NORTH HAINES CITY, FL 33844 863/422-4429 5032 US 27 NORTH SEBRING, FL 33870 863/382-3900 2800 A RIDGE WAY, STE 100 LAKE WALES, FL 33859 863/676-2008 1050 US 27 NORTH, SUITE 1 CLERMONT, FL 34711 352/394-8705 2025 EAST EDGEWOOD DRIVE LAKELAND, FL 33803 863/665-4515 2004 C.R. 540-A LAKELAND, FL 33813 863/937-4515 TOLL-FREE IN FLORIDA 800/282-3937

October 18, 2017 Dear Employer: Eye Specialists of Mid•Florida is pleased to provide businesses in the communities we serve with a comprehensive discount program to complement company vision plans or to provide employees who opt out of vision coverage with a sensible solution. Our Special Eyes Vision Discount Program is available at NO CHARGE to employers or their employees. In addition, your employees can sign up their spouse and dependents, also at no cost. Some of the companies and organizations who are taking advantage of Special Eyes include Chastain-Skillman, Phillips Business Forms, the School Board of Highlands County, and the Cities of Haines City, Sebring and Winter Haven. A brochure is attached describing Special Eyes in detail. Please also find a simple employer agreement form and an employee enrollment form for your review and consideration. I welcome the opportunity to speak with you directly and answer any questions you may have. You may contact me at 863-294-3504 ext. 1318, cell # 863-398-5610 or jolivier@eyesfl.com. Please check out our website at eyesfl.com to learn more about Eye Specialists of Mid•Florida. We have seven locations to conveniently serve your employees’ vision care needs in central Florida: Clermont, Haines City, Lake Wales, Lakeland–Edgewood, Lakeland–Highlands, Sebring and Winter Haven. In addition, our physicians and staff welcome the opportunity to be of service for your wellness program – health fairs, Lunch & Learns, etc. Warm regards,

Jennifer Olivier Jennifer Olivier, APR Marketing Manager

SPECIAL EYESVISION DISCOUNT PROGRAM

M E M B E R B E N E F I T I N F O R M A T I O N

HAINES CITY100 Patterson Road

Haines City, FL 33884863.422.4429

WINTER HAVEN407 Ave. K SE

Winter Haven, FL 33880863.294.3504

LAKELAND2004 CR 540-A

Lakeland, FL 33813863.937.4515

CLERMONT1050 U.S. Hwy 27 N, Suite 1

Clermont, FL 34714352.394.8705

LAKE WALES2800 A Ridge Way, Suite 100

Lake Wales, FL 33859863.676.2008

SEBRING5032 U.S. Hwy 27 NSebring, FL 33870

863.382.3900

LAKELAND2025 E. Edgewood Drive

Lakeland, FL 33803863.665.4515

Welcome to Eye Specialists of Mid•Florida, P.A.

Your employer wants the best for you and is proud to offer this quality vision care discount program to you, your spouse, and your dependents.

This comprehensive discount plan includes exams, eyewear, contact lenses, LASIK, and all the accessories needed to keep you seeing clearly.

As a leading eye care practice in Central Florida, our doctors specialize in routine vision exams, contact lenses, diagnosis and treatment of eye diseases including cataract, glaucoma, retina and laser vision correction (LASIK). Our commitment to maintaining and improving your gift of sight is what drives us to deliver the most comprehensive eye care offered today.

Few things can be considered more important to your quality of life than preserving your ability to see the world around you. That’s why we, at Eye Specialists of Mid•Florida, developed the Special Eyes Vision Discount Program.

(800) 282 – EYES (3937)

www.EyesFL.comfacebook.com/EyesFL

OUR MISSIONProvide the highest quality and most technologically advanced eye care

with compassion and integrity.

PROFESSIONAL SERVICES SPECIAL EYES DISCOUNT

Routine Comprehensive Eye Exam 30% Discount

Contact Lens Exam 30% Discount

Eyeglass Frames 30% Discount

LASIK Surgery 10% Discount

ADDITIONAL DISCOUNTS• 30% OFF Eyeglass Lenses• 30% OFF Non-Prescription Sunglasses• 15% OFF Contact Lenses• 15% OFF Accessories

The Special Eyes Vision Discount Plan cannot be combined with insurance programs, other discounts, or some specially priced packages. Some restrictions apply. All discounts are subject to change without notice.

Cataracts GlaucomaLasik OpticalRetina Eyelid Lifts

Interested? Sign up in your HR department to receive your discount card.

Special Eyes Vision Discount Program Employee Enrollment Form

Company Information

Company Name

Company Address

Company Contact Title Phone # Email

Employee Information

First Name Last Name

Address Phone Numbers D.O.B. Home: Cell: Spouse/Dependent First and Last Name Relationship to employee D.O.B. 1. 2.

3.

4.

5.

Eye Specialists of Mid-Florida’s Special Eyes Vision Discount Program may not be combined with any other offers, discounts, coupons or insurance benefits.

Special Eyes is offered at no charge to the employer or their employees. In addition, employees may add their spouse and dependents to the program at no charge. Special Eyes participants must present their membership card at the time of service to receive the benefits and discounts. Special Eyes is honored at all Eye Specialists of Mid-Florida locations.

Eye Specialists of Mid-Florida reserves the right to modify and/or discontinue the Special Eyes program at its discretion. Written notice of modifications or discontinuation of the program will be provided to the employer prior to implementation.

Employee Signature: __________________________________________________ Date: _____________________

Please return completed form to your HR/Benefits Dept. or directly to Eye Specialists via email to jolivier@eyesfl.com or fax to (863) 294-8305.

The patient and any other person responsible for payment has a right to refuse to pay, cancel payment, or be reimbursed for payment for any other service, examination or treatment that is performed as a result of and within 72 hours of responding to the advertisement for the discounted fee, or reduced fee service, examination or treatment.

Special Eyes Vision Discount Program Employer Agreement

Company Name Date

Company Address Company Phone Company Fax # of Employees

Contact Name Title

Direct line or ext. Email

___________________________________ understands Eye Specialists of Mid-Florida’s Special Eyes Vision Discount Program may not be combined with any other offers, discounts, coupons or insurance benefits.

Special Eyes is offered at no charge to the employer or their employees. In addition, employees may add their spouse and dependents to the program at no charge. Special Eyes participants must present their membership card at the time of service to receive the benefits and discounts. Special Eyes is honored at all Eye Specialist of Mid-Florida locations.

Upon request, a Special Eyes program representative will conduct informational meetings to familiarize employees with the program.

Additionally, special promotions provided for Special Eyes members may be sent to participants and/or to the employer for distribution at the employer’s place of business.

Eye Specialist of Mid-Florida reserves the right to modify and/or discontinue the Special Eyes program at its discretion. Written notice of modifications or discontinuation of the program will be provided to the employer prior to implementation.

________________________________________________ _____________________________________________ Employer’s Authorized Signature Eye Specialists of Mid-Florida Authorized Signature

________________________________________________ _____________________________________________ Print Name Print Name

________________________________________________ _____________________________________________ Title Title

________________________________________________ _____________________________________________ Date Date The patient and any other person responsible for payment has a right to refuse to pay, cancel payment, or be reimbursed for payment for any other service, examination or treatment that is performed as a result of and within 72 hours of responding to the advertisement for the discounted fee, or reduced fee service, examination or treatment.