Is this an eye injury or emergency?

What type of appointment are you wanting to schedule?

Please enter your personal information

All fields are required

Are you an existing patient?

Please Enter your Insurance Information

BlueCrossBlueShield, United Healthcare, Priority Health, Aetna, etc

Enter your medical insurance plan
Enter your vision insurance if any

Additional Notes

All fields are required

Are you a contact lens wearer?
Do you have glaucoma?

Please select a date and time

All fields are required

Review and Submit

Please review then click submit.

  • 1. Personal Details
    • :
    • :
    • :
    • :
    • :
  • 2. Appointment details
    • :
    • :
    • :
    • :