Appointment Request Form If this is an emergency, do not contact us via email, please use our emergency contact information. Appointment Request Form Basic form for clients to request an appointment with the practice. Please fill in the form below to setup an appointment. First Eye Care, now partnered with My Eye Dr, is currently not open for routine eye care. If you submitted an appointment request, we will respond to your request when we return to the office. All other requests are monitored and addressed when possible but we cannot get to all requests at this time. We are committed to reopening and operating with the health and well-being of our patients and staff. We regret any inconvenience this has caused.Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred Date & Times*Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.Patient Type*New patientReturning patientPlease let us know if you are a new or existing patient.Name* First Last Phone*Email* Best Time to be Reached for Confirmation* : HH MM AM PM CommentsNameThis field is for validation purposes and should be left unchanged.