Schedule an Appointment

To arrange a visit to our New Kensington or Penn Hills office, please complete and submit the form below.

Your Name
Date of Birth
Phone Number
Email
New Patient     Current Patient
Type of Insurance
Do you have a Doctor preference ?	yes no
If yes, list Doctor
Briefly describe the reason for appointment (eye exam, laser vision consult, visual fields, etc.)
I prefer an appointment at the following office: (Our office will contact you with the closest available appointment time.)
New Kensington	Date:		MM 01 02 03 04 05 06 07 08 09 10 11 12 DAY 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 20 21 22 23 24 25 26 27 28 29 30 31	Time:
New Kensington Office Hours are: Mon. & Wed. - 10:00 a.m.-6:00 p.m.; Tue.,Thu. & Fri. - 9:00 a.m.- 4:00 p.m.; Sat. - 9:00 a.m.-12:00 noon
Penn Hills	Date:		MM 01 02 03 04 05 06 07 08 09 10 11 12 DAY 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 20 21 22 23 24 25 26 27 28 29 30 31	Time:
Penn Hills Office Hours are: Mon. - 12:00 noon-7:00 p.m.; Tue. - 9:00 a.m.-4:00 p.m.; Wed. - 11:00 a.m.-6:00 p.m.; Fri. - 9:00 a.m.-4:00 p.m.; Sat. - 9:00 a.m.-12:00 noon

NEW KENSINGTON ~ 320 Central City Plaza | New Kensington, PA 15068 | 724.335.5721 ~

PENN HILLS ~ 509 Long Road | Pittsburgh, PA 15235 | 412.731.1930 ~