Appointment Request Form Book A General Eye Care Appointment Book A Dry Eye, Myopia Control, or Scleral Lens Appointment If this is an emergency, do not contact us via email, please use our emergency contact information. Please fill in the form below to setup an appointment.Appointment Type*Scleral Lenses: Consultation, Fitting, or Follow UpMyopia Control: Consultation, Fitting, or Follow UpDry Eye: Assessment, Treatment, or Follow UpPlease indicate what specialty appointment type you wish to book. For general eye care, please go to https://limelight.solutionreach.com/scheduling/subscriber/12671/schedulerReason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred Date & Times*Please let us know when you would prefer to have your appointment. Patient Type* New patient Returning patient Please let us know if you are a new or existing patient.Name* First Last Phone*Email* Best Time to be Reached for Confirmation* : Hours Minutes AM PM CommentsNameThis field is for validation purposes and should be left unchanged.