Harvey & Lewis

eye exams

Our affiliated doctors of optometry and ophthalmology are ready to serve you. With our 21-point eye examination, we’ll evaluate the health of your eyes, checking for such things as glaucoma, cataracts and retinal problems.

If you are a new patient, or haven't seen us in over a year, please click HERE to download a patient information form to fill out and bring with you to your appointment.
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schedule an exam

All fields must be filled out for us to schedule your appointment.

New patient? Changes to your insurance or address?
Click here to download a patient information form to bring to your appointment.

Check here if you would like to receive email notification to pick up your frames/contact lenses.

Check here if you would like to receive an appointment reminder via email.


CONTACT INFORMATION
Name:
Address:
City:	State:	Zip:
Email:	Phone:

INSURANCE INFORMATION

Name of insurance provider:

APPOINTMENT LOCATION

Canton	EXAMS AVAILABLE: MONDAYS, WEDNESDAYS, THURSDAYS & SATURDAYS
Glastonbury	EXAMS AVAILABLE: MONDAYS, TUESDAYS,THURSDAYS & SATURDAYS
Hartford—Downtown	EXAMS AVAILABLE: MONDAYS, TUESDAYS,THURSDAYS & FRIDAYS
Hartford Hospital	EXAMS AVAILABLE: MONDAYS,WEDNESDAYS & FRIDAYS
Kensington	EXAMS AVAILABLE: WEDNESDAYS, FRIDAYS & SATURDAYS
West Hartford	EXAMS AVAILABLE: MONDAYS, TUESDAYS, THURSDAYS & SATURDAYS


DATE AND TIME OF APPOINTMENT
To schedule an appointment within the next 72 hours, please call 1-800-TEST-EYES.
Date
Time (1st Choice)	Time (2nd Choice)

NOTES

Please use this space to indicate preferred doctor or other special needs/concerns.

You will recieve an e-mail within 24 hours of your appointment request and a follow-up phone call to confirm the time of your appointment.
If you do not recieve a confirmation e-mail, please call the location where you wish to make an appointment.


	Harvey and Lewis Opticians \| 45 Asylum Street Hartford, CT 06103 \|Tel 860-522-2020 \| Fax 860-522-5277 \| info@harveyandlewis.com Web Development by Crucial Networking