Appointment Request Form Please fill in the form below to setup a dry eye 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.Name* First Last Phone*Email* HiddenBest Time to be Reached for Confirmation : Hours Minutes AM PM AM/PM CommentsCAPTCHAEmailThis field is for validation purposes and should be left unchanged.