Appointments"*" indicates required fields Please complete the following form to request an appointment. If you are experiencing a vision threatening emergency/urgency, please pick up the phone and call us DO NOT use this platform to schedule your appointment. Additionally, please do not send personal health information, we will address your specific needs at your appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!Name*Phone*Email* Preferred TimeMorningAfternoonEveningDate of Birth* MM slash DD slash YYYY Do you have insurance?No insuranceYes, insuranceInsurance Name?Nature of VisitEmailThis field is for validation purposes and should be left unchanged.
