Appointment Scheduler

Please choose one

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Male Female

BlueCrossBlueShield, United Healthcare, Priority Health, Aetna, etc

Enter your vision insurance if any

Who is the primary insured party?

Optional - upload your vision insurance card
(Files accepted: gif,jpg,jpeg,.png)

Enter your medical insurance plan

Who is the primary insured party?

Optional - upload your medical insurance card
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All fields are required

If you desire a contact lens evaluation, would this be your first time trying contacts?

Are you diabetic?

Do any of the following eye conditions apply to you?

None

Cataracts

Glaucoma

Macular Degeneration

Other

What is the main reason for this visit?

Patient Portal

Do you have portal access?

The patient portal is where you'll find your forms, records, and visit history. Let us know where you stand so we can point you the right way.

Yes, I have access No, not yet

Trouble signing in? Call or text the office and we'll help.

Please review then click submit.

1. Personal Details
- First Name:
- Last Name:
- Dob:
- Email:
- Phone:
2. Appointment details
- Reason for visit:
- Appointment time:
- Location:
- Provider: