Thank you for scheduling an exam at our office! We look forward to meeting you, but need a little more information about your upcoming visit before we are ready to see you. Please fill out this form as soon as possible.
IF WE DO NOT RECEIVE THIS COMPLETED FORM BEFORE YOUR SCHEDULED APPOINTMENT TIME, WE MAY NEED TO RESCHEDULE YOUR APPOINTMENT TO ANOTHER DATE/TIME. If you have any questions, feel free to call us at 502-996-7450.