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Home » Contact Us » Patient Forms » Online Patient Registration Form

Online Patient Registration Form

Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office. This form contains confidential information and is delivered to your doctor through a secure Internet connection.

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OUR OFFICE IS NOW OPEN!

Due to our new limited hours, please call or text our office to schedule an appointment.

We are also offering curbside pick up for all glasses & contacts

Thank you for your continued patience and loyalty during these challenging times.