My $0.02
This is how I do it, (YMMV):
1."we include the first trial lens on all disposable fits for no additional charge"
2. We have 3 pricing groups: 1. new or former patient, 1st timer 2. new pt, previous wearer, and 3. former pt, previous wearer. We have 2 tiers in each groups: standard and premium. Std is spherical anything (except continuous wear or RGP) Prem. is everything else. We also have a Prem plus(extra $25), which is 2 or more Premium types (like toric monovision, modified monovision, RGP monovision, or continuous wear toric). So the most expensive is Premium Plus, 1st timer and the cheapest is former patient, previous wearer sphere. I don't charge a fitting fee if the pt tries them on and decides against the fit, or can't be trained to try the lens on in 30+ minutes. I do charge if they say they want to try them a week. No refunds for professional services.
3. We try something else or stop if they want to (if we've tried everything that makes sense, or everything that is available, I may suggest that we are running out of options, but I have 1 more lens that I want them to try) this doesn't happen very often. If you feel like you didn't try hard enough, give them their money back.
4. Yes, I don't typically hear complaints with comfort.
5. This ain't the Pepsi Challenge. If the change is physician directed, the fitting fee covers all trial lenses. If Joe Blow wants to try them all, 1 fitting fee for each pair of lenses (different brand each eye).