Appointments to our office can be made by telephone or through email request below.

Our office hours are:

7:15 am to 5:00 pm Monday
7:15 am to 4:00 pm Tuesday through Friday

We make every attempt to accommodate your schedule needs. Emergency requests are given priority status.

Request an Appointment
This service is ONLY FOR NON-URGENT appointment requests. If the patient has an urgent medical problem, call our office at 203-978-0800.

* = Required Information

Referral Information:
Have you been referred to our office by a doctor, family member, or friend?



Their First Name:
Their Last Name:

Patient Information:*
First Name:
Last Name:

Phone Number(s):*
Our office will use these numbers to confirm request.

Preferred: - -
Alternate: - -
Email:

Patient Type: *

Patient

Appointment Type:*
(For urgent issues, please call the physician's office immediately.)


Requested Date:*  

First Available

 
  mm         dd          yyyy
Specific Date:
  mm         dd          yyyy
Specific Week/Month: through
 
   
Preferred Day(s): Preferred Time(s):
Any Day
        Monday
        Tuesday
        Wednesday
        Thursday
        Friday		 Any Time
        Early AM
        Late AM
        Early PM
        Late PM

Patient Health Insurance Provider:*

For New Patients:  
Do you wear glasses?
No
Do you wear contact lenses?
No
      If yes, what type? Soft Daily Wear (conventional)
  Rigid Gas Permeables
  Disposables
  Extended Wear Lenses
      If no, are you interested in
      wearing contact lenses?
Yes No


 

 

  
       
Home
Meet Our Doctors
Our Staff
Eye Care Services
The Eye Glass Store
courtesy Coupons
Contact Lenses
Prescription Refills
Appointments
New Patient Forms
Insurance Plans
Directions
Contact Us
Sitemap
 
 
   

site design: high rez designs inc.