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Appointment Request Form

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

The COVID-19 shutdown and ongoing measures have severely affected our schedule. Unfortunately, all appointments scheduled prior to our shutdown on March 18 have been cancelled. We are working to contact all affected patients and reschedule their exams as soon as possible. If you would like to be put on our list to contact for appointments, please complete the form below. Be sure to include notes if there's something specific you're looking for. We are working through the list and will contact you as soon as possible to set up your appointment.

Please note that we have received hundreds of requests and are working hard to schedule everyone within our limited capacity. You may not hear back right away. Please do not submit duplicate requests.

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. 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.
    Please let us know if you are a new or existing patient.
  • This field is for validation purposes and should be left unchanged.