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 is OPEN for ALL of your eye and vision care needs! Please 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, including temperature checks, 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.

Thank you for your patience and support as we maintain a healthy, safe environment for all.

We look forward to seeing you soon!

To request an appointment please click HERE and to register for your appointment click HERE.

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