Schedule A Vision Therapy Evaluation

	Schedule an Appointment
	If you are ready to schedule an evaluation, please complete and submit the form below. We will contact you shortly to confirm an appointment time. Testing is scheduled Tuesday through Friday between 8 am and 4 pm. (All fields are required.) New Patient? Yes No Patient's Full Name Parent/Caregiver Full Name Address City - State - Zip E-mail Address We will NOT share your information with anyone. (We hate spam too!) Phone Best way to contact Best time to contact Reason for visit Preferred Appointment