Appointment Request

The first step towards a better, clearer vision is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment. (* - required fields)

Please do not use this form to cancel or change an existing appointment.


Name:  * Best time(s) to call?
Address:  
City:  
State/Province:  
Zip/Postal:  
Email:  *
Phone:  *
How Did You Hear About Us?
  * (Google, Yahoo, Facebook, Etc)
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?

Please indicate the nature of your appointment:
 Eye Exam (Glasses/Contacts)  LASIK Consultation  Cataract Consultation
 Other (please briefly explain below)
 
 



Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.
Ready for your first appointment?