Appointments

If you would like to schedule an appointment, please complete the fields below and someone from our office will contact you to confirm your appointment details.

Required information:
Title:
First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip:
Phone (day):
Phone (evening):
Best time to call:
Optional, but helpful information:
Reason for Appointment:
I am available for an appointment on:		Please do not request a "same day appointment" via this website.
Your Optometrist:
Preferred doctor:
Preferred location:
Type of medical insurance:
What should the doctor know about you? This is not a secure contact form. Please understand that you are submitting this request over the internet. Do not include sensitive medical information in your appointment request, for we cannot guarantee that it will not be seen by other parties. Until you receive a phone call from our scheduler, you do not have an actual approintment. Thanks for your understanding.
:
By using this form you are submitting a request only. Until you receive a telephone call from our schedule you do not have an actual appointment. Thanks for your understanding.