accessibility ACCESSIBILITY

Appointment Request

The first step towards better 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.

Please do not use this form to cancel or change an existing appointment.
*Items in bold are required.


Which office location(s) would you prefer for your appointment?



Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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NOTE: Messages sent using this form are not considered private.  Please contact our office by telephone if sending highly confidential or private information 

Once you have set up your consultation appointment with us, we ask that you print out our patient forms and bring it with you to your visit.

 

New Patient Forms



This saves you time in the office and also helps us provide you with a faster service.

Patient Registration Form - This form allows us to get demographics and other important information such as current medications and surgical history.

Financial Responsibility Form - This form explains our office policies. Please note that copays, deductibles, coinsurances, refraction fees, and any unpaid balance is due at the time of check in. Please keep this form for your records.

HIPAA Authorization Form - This form authorizes us to protect your health insurance information and allows us to use your information to better care. You can also use this form to elect a representative for you. (To help schedule appointments, etc.)

Patients, would you be interested in signing up to our Free Patient Portal? With the Patient Portal, you can:

  • Request an appointment
  • Send messages to our practice
  • Make credit card payments online

If you'd like to take advantage of this efficient tool, please contact our office and we will gladly provide you with the necessary information. You will receive a confirmation email from the Patient Portal that looks like this

 Along with your filled out forms, please also bring:

  • Insurance card(s)
  • Insurance referral (Kindly call your insurance company to determine if you require a referral from your primary doctor to see a specialist)
  • Driver's License or Photo ID

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