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Schedule an Appointment

Please complete the form below and someone from our office will contact you shortly to confirm your appointment date and time. Please be aware that you are submitting a request only. Until a representative from our office has contacted you, you do not have an actual appointment.

We cannot schedule a "same day appointment" via this website, however, same day appointments may often be available. Please call the IEC office nearest you if you are interested in an appointment today. (For Lasik Consultations: Contact lens wearers must leave lenses out for a period of time prior to appointment. Our patient service representative will go over details).

Note: All required fields are marked *

*Name

Address

City

State

Zip Code 

*Phone: 

*E-Mail: 

*Confirm E-Mail: 

*Daytime Phone

Evening Phone

*Best way to contact

Date of Birth - mm/dd/yy

*Preferred day for appointment

*Preferred appointment time

*Location for appointment

*Type of visit


If reason unlisted, fill out the "Other" field below.

Other:

   
 
 

NEW PATIENT FORM

If you have already scheduled your new patient exam and have received conformation of date and time of appointment, please print this form, fill out completely and bring with you to your appointment. IEC New Patient Form.pdf

LASIK CONSULTATION appointments use Lasik New Patient Form.pdf

Download and Print Forms

To view and print forms you will need Adobe Reader which can be downloaded for free by clicking on the icon below.

adobe
http://www.adobe.com/products/acrobat/readstep2.html

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