New & Existing Patients

Request an Appointment

Fill out the form below and our staff will contact you to confirm your visit. For urgent eye problems, please call us directly.

First Name * Last Name *

Are you a current patient? *

Phone * Email *

Preferred Doctor Preferred Date

Reason for Visit

This form is a request, not a confirmed appointment. Our staff will contact you to finalize your visit.

⚠️ Not for emergencies or urgent problems

If you are experiencing a medical emergency, call 911 or go to the nearest emergency room. Do not use this form for urgent medical problems. Messages are typically answered within 1–2 business days while the office is open.

I understand this form is not for emergencies or urgent medical problems, that I should call 911 or seek emergency care for emergencies, and that requests are typically answered within 1–2 business days.