Appointments Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment. Please complete the following form to request an appointment. Please note that availability will vary depending on your request. Upon receiving your request, a member of our staff will contact you either by phone or email to set up your appointment.NamePhone*Email* Preferred Date* Preferred TimeMorningAfternoonEveningNew or Established PatientNew PatientEstablished PatientCurrently WearingGlassesContact LensesBothNoneNature of VisitCommentsThis field is for validation purposes and should be left unchanged.