Comprehensive Eye Exam Learn More Contact Lens Services Learn More Dry Eye Clinic Learn More Eye Injuries & Infections Learn More Surgical Co-Management Learn More Optical Boutique Learn More 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 also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!NamePhone*Email* Preferred Date* Date Format: MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningServices RequestedEye ExamEye ProblemContact Lens ExamDry Eye TreatmentNature of VisitCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.