MyEyeDr. Receipt Generator
Enter the office, patient, services, insurance and payment, then download the MyEyeDr. invoice as a US Letter PDF or PNG.
EDITOR
Receipt details
Edit your receipt below, then download the same clean layout as PDF or PNG. Enter amounts and totals manually.
What the MyEyeDr. invoice shows
MyEyeDr. offices print an Invoice at checkout that doubles as the receipt. It shows the office (state and city), the office number, service date, payment number and employee, the patient name, and a table with each service or eyewear item, its procedure code, the retail price, discount, insurance allowance, insurance copay and patient due, with the order number and vision plan above the lines. A box shows your savings with the plan, then Tax/Fee, Total Due, Payment and Balance, a Promise Date for glasses and the card used. This myeyedr receipt follows that invoice, which is what FSA and HSA administrators ask for.
How to use this receipt
| Step | Details |
|---|---|
| 1 | Keep the logo and enter the office name, address and phone. |
| 2 | Fill in the office number, service date, payment number, employee and patient. |
| 3 | Enter the order number and insurance, then each service or item with code, retail price, discount, allowance, copay and patient due. |
| 4 | Update the totals, savings box, Tax/Fee, Total Due, Payment, Balance and Promise Date. |
| 5 | Add the payment line and download the PDF or PNG. |
FAQs
How do I get an itemized receipt from MyEyeDr.?
Ask the office for a copy of your invoice, or sign in to My Account on myeyedr.com; the invoice lists each service, the insurance amounts and what you paid.
Can I use FSA or HSA funds at MyEyeDr.?
Yes. Eye exams, prescription glasses and contacts are eligible medical expenses; submit the itemized invoice showing the patient due and payment.
What is the Promise Date?
The date your glasses or contacts are expected to be ready; exam-only invoices show N/A.
Are the example details real?
No. The office, patient, numbers and card are fictional; prices are typical. MyEyeDr. is a trademark of Capital Vision Services, LLC; this site is not affiliated.