Sign up to become a ForeseeHome referral partner by completing this form. You do not need to complete the form if your practice has previously ordered ForeseeHome for a patient. To change contact information or for questions about submitting a referral, please email email@example.com or call Practice Engagement at 1-888-600-3112.
The ForeseeHome is intended for use in the detection and characterization of central and paracentral metamorphopsia (visual distortion) in patients with age-related macular degeneration, as an aid in monitoring progression of disease factors causing metamorphopsia including but not limited to choroidal neovascularization (CNV). It is intended to be used at home for patients with stable fixation.
The ForeseeHome AMD Monitoring Program is only available by physician order and is intended to be used as an addition to regular eye exams.
The technical component of the ForeseeHome AMD Monitoring Program is covered by Medicare, subject to its coverage requirements for the test, to assess patients with dry AMD who are at risk of developing wet AMD. Please refer to your local Medicare Administrative Contractor (MAC) for which the ordering physician resides concerning coverage availability for the physician professional services component of the test.