Please fill out and bring in the completed forms listed below.

Patient Sign In Form

Contact Lens Policy




Appointment Request

Please fill out the form to request an appointment

Full Name(*)

Email Address (*)

Daytime Phone Number (*)

Evening Phone Number

Doctor's Name

This is not an automated appointment scheduling service. Please enter up to 3 requested dates and times and we will do our best to accommodate you.

1st Requested Date / Time

2nd Requested Date / Time

3rd Requested Date / Time

Reason for Appointment / Comments