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 or your personal or insurance information has changed please click HERE to download a patient information form to fill out and bring with you to your appointment.

Fields marked with a * 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.

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

INSURANCE INFORMATION

Name of insurance provider:

Policy number:

APPOINTMENT LOCATION*

Bristol EXAMS AVAILABLE: MONDAYS, WEDNESDAYS, THURSDAYS & FRIDAYS Canton EXAMS AVAILABLE: MONDAYS, WEDNESDAYS, THURSDAYS & SATURDAYS Enfield Square EXAMS AVAILABLE: MONDAYS, WEDNESDAYS, THURSDAYS & SATURDAYS Farmington EXAMS AVAILABLE: MONDAYS - FRIDAYS & SATURDAYS Glastonbury EXAMS AVAILABLE: MONDAYS, TUESDAYS,THURSDAYS & SATURDAYS Hartford—Downtown EXAMS AVAILABLE: MONDAYS - FRIDAYS Hartford Hospital EXAMS AVAILABLE: MONDAYS,WEDNESDAYS & FRIDAYS Kensington EXAMS AVAILABLE: WEDNESDAYS & 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) Morning Mid-Day Afternoon	Time (2nd Choice) Morning Mid-Day Afternoon

NOTES

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

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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.