Appointment Request Form

Advanced Medical Services

The form below is intended to help patients schedule a consultation or eye exam for specific services, including Specialty Contact Lens Fitting, Scleral Lens Fitting, Keratoconus Consultation Orthokeratology Fitting, or Myopia Control Consultation.

Please fill in the form below to setup an appointment.
Reason for Appointment*
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date*
Date Format: MM slash DD slash YYYY
Preferred Time*
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Phone*
Email*
Comments
Phone
This field is for validation purposes and should be left unchanged.

Looking for an Eye Exam?

Access our online schedule here!

If you're looking for a routine eye exam, contact lens fitting, medical eye exam, or anything related to general eye care, we recommend you go to our online scheduler to find a time that's convenient for you.

Request an Appointment Online