Appointment Request Form

If this is an emergency, do not contact us via email, please use our emergency contact information.

Complete the following form:

Please fill in the form below to setup an appointment.
Doctor
Reason for Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Phone*
Email*
Best Time to be Reached for Confirmation*

: HH

MM
Comments
Name
This field is for validation purposes and should be left unchanged.

Dear Patient Family:

Our office will be opening soon for ALL of your eye and vision care needs!

lease be advised that in order to protect our patient community, staff, and community-at-large, we will have additional safeguards in place when you come to our office. Face coverings will be required for entry. We have a limited supply for individuals who may need them. We will screen visitors for symptoms of the coronavirus and we appreciate your understanding in this process which is also followed by all staff, including the doctor.

Please limit the number of individuals accompanying you to the office for your examination or dispensing to only those absolutely necessary.

We have missed seeing so many of you and will be working diligently to make room for patients who have had their appointments rescheduled, as well as those that are due. Thank you for your patience and support throughout these past many weeks.

We will see you soon!

Thank you for your patience and understanding of these difficult circumstances.

Please check our Facebook page for important office updates regarding COVID-19.

If you need to order contact lenses, please click here.

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