Appointment Scheduler

To book an appointment,
please select a provider.

What is the reason for this visit?

Please choose one

Please select a date and time

All fields are required

Please enter your personal information

All fields are required

Male Female

Are you an existing patient?

Additional Notes

All fields are required

What is the primary reason for this visit?

Please Enter your Medical Insurance Information

BlueCrossBlueShield, United Healthcare, Cigna, Aetna, etc

Enter your medical insurance plan

Please Enter Your Vision Insurance Information

Medical insurances typically outsource vision to a group such as VSP, Eyemed, Spectera, Superior, etc.

Enter your vision insurance if any

Who is the primary insured party?

Necessary but Boring Paperwork

By signing this form (whether by original, facsimile, or electronic),I understand I am ultimately responsible for all payment obligations arising out of my treatment or care and guarantee payment for these services. I acknowledge that I have read, understand, and agree to the terms of this agreement.

Patient Name*

Date*

Review and Submit

Please review then click submit.

1. Personal Details
- First Name:
- Last Name:
- Dob:
- Email:
- Phone:
2. Appointment details
- Reason for visit:
- Appointment time:
- Provider:

Important! When you click submit, please wait while we schedule your appointment.
You will receive an email confirming your request, if you do not receive an email please call or text our office to ensure your request was accepted.

To book an appointment, please select a provider.

What is the reason for this visit?

Please select a date and time

Please enter your personal information

Additional Notes

Please Enter your Medical Insurance Information

Please Enter Your Vision Insurance Information

Necessary but Boring Paperwork

Necessary but Boring Paperwork

Review and Submit

1. Personal Details

2. Appointment details

To book an appointment,
please select a provider.