New Patient Appointment Request

Please choose a type of encounter below. If you choose a Telemedicine encounter, we will send you instructions on how to join the video conference.

You can text me on this number (established patients only)

Best way to confirm appointment? *

New Patient? *

Preferred Doctor (optional)

Encounter Type? *

Requested Date/Time? *

Please understand this is not a booking service! You will be contacted by our office to confirm or find alternative appointment slot.

Do you have a vision discount plan? *

No, I have medical insurance only

EyeMed (Blue View Vision)

VSP

I will be self-pay

Other/Unknown

We only contract with VSP and EyeMed for common visual diagnoses; however, you can still see one of our doctors and request reimbursement from one of the other vision discount plans using this link (opens in new tab). Please understand that vision discount plans MAY NOT be eligible to cover your exam if you have medical complaints OR if there is a significant unknown medical issue found during your exam that must be addressed by the doctor. Please contact our office for more information if you are confused.

Would you like the doctor to address a medical complaint? *

Yes, I have additional issues besides blurry vision

No, I only have routine blurry vision complaints

I do not understand

All medical complaints (floating spots, itchy eyes, eye pain, eyelid bumps, headaches, etc) must be billed to medical insurance - not to a vision discount plan.

Additional Notes

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Name

Office Hours

Monday – Friday	8:00 am – 5:00 pm
Saturday	Closed
Sunday	Closed