Online Appointment Request Form If this is an emergency, do not contact us via email, please call 911 or go to the nearest emergency room. Please note this is an appointment request, our online scheduler will be contacting you to confirm this request. You are not booking an appointment by submitting this request.Type of Appointment*Please ChooseGeneral OptometryDry EyePatient Type* New Patient Returning Patient Name* First Last Phone Number*Email* Reason for Appointment* Routine Exam (interested in contact lenses) Routine Exam (not interested contact lenses) Medical Office Visit (redness, pain, injury. etc) Vision Insurance Provider*VSPEyemedCommunity EyePrivate PayMedical Insurance Provider* Preferred Dates and TimesPlease note we do not schedule appointments between 1:00 - 2:00 PM.Please check your preferred time:* MORNING AFTERNOON CommentsNo Show PolicyTriangle Family Eye Care will assess a fee of $35 for anyone who schedules an appointment and fails to give our office a 24 hour cancellation notice. The same fee will be assessed for any no show appointments.EmailThis field is for validation purposes and should be left unchanged.
