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Make An Appointment:
For ocular emergencies day or night...
CALL 410-893-0480 or 911.
Do not use this email.

By Phone:
Bel Air Office - 410-893-0480
Perry Hall Office - 410-529-1922
Havre de Grace - 410-939-5015

Online:
Do not use this email for an emergency.

Please complete and submit the form below to make any type of an appointment. A staff member will call you as soon as possible during working hours.

Save time when you come in...download and complete your Health History Form now.

*First Name:

*Last Name:

Address me as:

*Email:

*Daytime Phone:

Nighttime Phone:

Please select a month, date and time that might work
best for your appointment:

Month

Date

Day and time

I prefer to be
contacted via the
following to confirm
that the appointment
is available:

Email
Home Phone
Cell Phone
Work Phone

I prefer to be
contacted during:

Weekdays (AM)
(8:00am - Noon)

Weekdays (PM)
(Noon - 5:00pm)

Appointment Type:

Laser Vision Correction Evaluation
General Eye Exam
Other/Please Specify

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