Make an Appointment

Please take a moment to fill out the information below to request an appointment and a member of our staff will be in touch with you shortly to schedule and confirm your appointment. We look forward to seeing you!

If you believe it’s an emergency please contact our office immediately by phone.

Before arriving at your appointment, we suggest that our patients gather the following information to help answer any questions you may be asked at your appointment:

Symptoms of current eye problems (double vision, loss of vision, flashes of light, difficulty seeing at night, etc.)
Previous eye injuries or eye surgeries
Family history of eye problems including glaucoma, macular degeneration, cataracts, etc.
General health conditions (allergies, chronic health problems, past surgeries, etc.).
A list of all current prescriptions and over-the-counter drugs.
Medical AND vision insurance card.

Contact Information
Please provide current contact information so that we can contact you to confirm your appointment.
Name*
Phone*
Email*
Patient Status*
- New Patient
- Existing Patient
Insurance Provider
Date & Times
Please be aware that appointments must be requested at least 1 day(s) in advance.
Preferred Date*
MM slash DD slash YYYY
Alternate Date
MM slash DD slash YYYY
Time*
Comments
Important: Please note that the date and time you requested may not be available. We will contact you to confirm your actual appointment details.

Make an Appointment

Please take a moment to fill out the information below to request an appointment and a member of our staff will be in touch with you shortly to schedule and confirm your appointment. We look forward to seeing you!

Contact Information

Date & Times