Request an Appointment

Interested in an appointment at one of our 5 locations? Complete the form below. We look forward to seeing you!

Please fill out this form in its entirety and hit submit. After submission of this form, expect a call from our office to schedule your appointment.
  • Preferred Practice Location

    Please select the office where you would like to be seen.
  • Contact Information

    Please provide the following information so that we may contact you to schedule your appointment for a visit. This form will not automatically schedule your appointment, you will receive a call from our office to schedule your appointment date and time.
  • Include preferred date/times and any other applicable details.
  • This field is for validation purposes and should be left unchanged.

Please note: this form should not be used for eye emergencies. For eye emergencies please call our office at 757-426-2020 and select the on-call doctor option (option 7) from the automated greeting.