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Home » Contact Us » Appointment Request Form

Appointment Request Form

If this is an emergency, do not contact us via email, please use our emergency contact information.

To request your next appointment, please complete the form below and let us know the most convenient time and date for you. Please don’t forget to include accurate contact details so we can follow up with you to finalize your request.

  • Please fill in the form below to setup an appointment.
    Please let us know if you are a new or existing patient.
  • If you are a new patient, please describe your Dry Eye symptoms. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
  • :
  • This field is for validation purposes and should be left unchanged.