Schedule an Appointment Online

Please fill out this brief survey for our information.  The reason for the survey is two-fold. We would like to reconnect and build a database of the temporary locations of our families and to start to get a clearer picture of your intentions for the remainder of the school year and beyond.  Of course, it is our fervent desire that we will all be together again soon, but need solid information to assist with our planning.

Patient Name
Address
City
State	Zip
Phone Number
Alternate Phone Number
Email Address
Type of Patient	New     Existing
Medical Insurance
Routine Vision Insurance
Choose Location
Choose Doctor
Available Days and Times
Select Date that corresponds to the available days of the doctor
What times work for you? (Enter in an exact time or a range)
Confirm my appointment...	by phone   by email