Appointment Request Form If you are experiencing an eye emergency please call 814-777-2475 or seek immediate medical attention. Please fill in the form below to setup an appointment.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 patient Returning patient Please let us know if you are a new or existing patient.Name* First Last Phone*Email* Best Time to be Reached for Confirmation* : Hours Minutes AM PM AM/PM CommentsCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
