Use the appropriate form below to reach our office. If you would like to place an order for contact lenses, please include the following in the Comments section of the form:
Patient Name
Patient Date of Birth
Address you would like to have the lenses shipped to
Supply of lenses you wish to order
(Year supply = No shipping charges!)
Please also be certain to include either your telephone number or email address so we may contact you. If you are placing an order for contact lenses, we will be obtaining payment information from you at that time.
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Contact Form
We'd love to hear from you. Use this email form to get in touch. -
Patient Registration/Medical History Form
Save time on your next visit by printing and completing this form before your appointment. -
Appointment Request Form
Fill in the form below to request an appointment at any of our convenient locations.
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Customer Satisfaction Survey
We are always working to improve our services and value your input. Please complete this short survey about your experiences with our Practice.
Contact Information
| Briarwood Mall | |
|---|---|
| Phone: 734-994-1444 Fax: 734-994-6476 |
