REQUEST AN APPOINTMENT

• Contact us today to schedule

  Call 702-362-3900 or fill out the form below.

• If this is an Emergency Referral please contact our office at 702-362-3900.
• First Name
• Last Name
• Email
  
• Phone
• Time
  :
  HH
  
  MM
  AMPM
• Date
  
  
• Appointment Type*:
  • 
    Cataract Exam
  • 
    LASIK Consultation
  • 
    Follow Up/Post-Op
  • 
    Annual Eye Exam
  • 
    Contact Lens and/or Glasses Exam
  • 
    Medical Eye Exam
  • 
    Other
• How Did You Hear About Us?
  • 
    TV
  • 
    RADIO
  • 
    NEWSPAPER
  • 
    ONLINE
  • 
    OTHER

  Select one

• Referring DoctorDo you have a referring doctor, such as an optometrist, ophthalmologist, primary care doctors? (It’s ok if you don’t. We just want to include them in your care).
• Attach Patient's Any File (Optional)File type: docx, pdf, jpeg, jpg or png. Max file size: 20MB If your file is a different type please change the type or contact 702-362-3900.