Appointment Request

We appreciate your confidence in us and look forward to serving you. Please complete the information below and one of our scheduling coordinators will contact you to schedule an appointment.

IF THIS IS AN EMERGENCY: Please call our office at 919.881.0900 and follow the prompts to leave a message for the doctor on call. Your call will be returned in the next 20 minutes. If for any reason your call is not returned, please call 911 or proceed to the nearest emergency room. This site is not monitored for emergency care.

Patient’s last name: * First: * Middle: *
Street address: * City: * State: * Zip code: *
DOB* Email* Phone*

Reason for visit:

 Comprehensive Eye Exam
 Laser Vision Evaluation
 Injury
 Blurred Vision
 Headache 		 Cataract
 Contact Lenses
 Loss of Vision
 Red Eye
 Itching 		 Glaucoma
 Tearing
 Infection
 Double Vision
 Pain

 Other Please list any other reasons

What vision insurance will we be filing for you? *

Appointment Location: * 

First Preferred Date: * 

Second Preferred Date: * 

Preferred Time: * 

Preferred Appointment Confirmation Method: * 

 

Office Locations

Raleigh
3214 Charles B. Root Wynd
Raleigh, NC 27612
Driving Directions

Cary/Morrisville
3603 Davis Drive Suite 100
Morrisville NC 27560
Driving Directions

Office Hours

RaleighMorrisville
Monday8am-7pm9am-7pm
Tuesday8am-6pm9am-6pm
Wednesday8am-7pm9am-7pm
Thursday8am-6pm9am-6pm
Friday8am-1pm9am-2pm
Saturday9am-2pm9am-2pm

Ask The Doctor