Schedule an Appointment with EyeOptix

Would you like us to schedule an appointment for you?

Appointment Form:

Name:

Phone Number:

The reason for your appointment:

Fill in area below for more information:

Which location would be most convenient for you?	1960 Randolph Road 2550 W Arrowood Rd 1525 W. WT Harris Blvd., Bldg. 1A1 (Wachovia Employees Only) Uptown-114 S. Tryon Street Ballantyne-15640 John J. Delaney Dr. Midland-12925 Hwy. 601 S.
Do you have a particular date in mind?	Yes No
If yes, please specify:
If no, what day of the week and/or time of the day is most convenient for you?
Is there any other information or comments you would like us to know?
How would you prefer we contact you? If you checked email provide that here:	E-Mail Home Phone Work Phone

New Patients | Click Here

Established Patients| Click Here

Children & Teens | Click Here

We will contact you shortly with your appointment selection.

Thank you in advance for completing our forms. It will ensure we have accurate information in our files and will save you time in the office.