Patient intake

Let's get you on the schedule.

A few quick details so we can prepare for your visit. This takes about two minutes.

What this form is for: scheduling and contact basics only. We don't collect medical history, symptoms, or current prescription details here — that's covered in person, or through a secure patient portal, when you come in.

Your details

First name

Last name

Phone number

Are you a new or returning patient?

New patient

Returning patient

Your visit

Reason for visit

Preferred date

Preferred time

Anything we should know before you arrive? (optional — scheduling notes only, e.g. "running late usually" or "first-time contact lens wearer")

Consent

Submissions email our front desk directly. We'll confirm your appointment by phone or text.

You're on the list.

Thanks — we've received your details. Our team will reach out shortly to confirm your appointment time.

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