Make an Appointment

Fill in the blanks below and enter your request.  When done, click "Submit Appointment Request" at the bottom. 

Our office will call you to confirm your request

* - required *How did you find us?: Advertisement Team Sponsor Yellow Pages Race Sponsor Other *Full name: *Telephone: - - x *Email address: *Type of exam requested: Select General Eye Exam Contact Lens Exam Glasses School Exam Eye Pathology Other *Filing insurance?: Select No Medicare VBA Aetna/Us Health VSP NVA Other *Been A patient here before?: Yes No *Preferred appointment day: Jan Feb March April May June July Aug Sep Oct Nov Dec / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 *Appointment time: 01 02 03 04 05 06 07 08 09 10 11 12 : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 AM PM

Our office will call you to confirm your request

*Our patient hours are :

No appointments between 1:00 and 2:30 p.m. 

Appointments are made every half hour (3:00, 3:30, etc...)