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  • Desired Appointment Date and Time  
      
  • Name *  
  • Email *     
  • Phone *  

  • The reason for my visit



  • If there is a problem with your eyes, please explain





  • If you have Insurance, please provide us with the following information.
  • MEDICAL Insurance (Name and Type i.e. Aetna HMO)
  • Group Number
  • Account Number
  •  
  • Vision Insurance (Name and Type i.e. Eyemed, Superior Vision, etc)
  • Group Number
  • Account Number
  •  

 


Carrollton Office Hours

Monday 2:00pm to 6:00pm
Tuesday 9:30am to 6:00pm
Wednesday 9:30am to 6:00pm
Thursday 9:30am to 6:00pm
Friday 9:30am to 6:00pm
Saturday 9:00am to 1:00pm


Forms
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New Patient Form
Returning Patient Form

Notice of Privacy Practices
Aviso de Prácticas de Privacidad
Contact Lens Care Guide

 

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