Appointment Form for Ortho-K Consultation Appointment Form for Ortho-K Consultation Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred Date & TimesPlease let us know when you would prefer to have your appointment. Our hours are listed on our location page.Patient Type* New patient Returning patient Please let us know if you are a new or existing patient.Name First Last PhoneEmail Does the patient currently wear glasses and/or contact lenses? Yes No Best Time to be Reached for Confirmation* : Hours Minutes AM PM AM/PM Comments
