Harvey & Lewis  
 
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specs appeal


Name*
Email Address*
Phone Number*
Consultation Time (1st Choice)*
Consultation Time (2nd Choice)
What is your eye color?
What is your hair color?
What is your skin tone?
Would you like to schedule an eye exam before or
after your consultation?
Yes, before. 
Yes, after. 
No thanks. 
Name of Insurance Provider
Would you like to upload a picture of yourself so
Debbie can begin selecting your frames?
 
 
  Harvey and Lewis Opticians | 45 Asylum Street Hartford, CT 06103 |Tel 860-522-2020 | Fax 860-522-5277 | info@harveyandlewis.com
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