Schedule an appointment appointment First Name * Last Name * Email Address * Phone * Date of Birth * Date isn't valid. (eg. mm/dd/yyyy) Phone Type * Home Cell Work I would like my confirmation by: * Email Text Preferred Appointment Day * No PreferenceMondayTuesdayWednesdayThursdayFriday Preferred Appointment Time * No PreferenceMorningAfternoon Please indicate below the purpose for your visit (check all that apply): * Eye Glass Examination Contact Lens Examination Laser Vision Correction Consultation/PreOP Medical Office Visit Scheduled Checkup/Followup General Consultation (Other) Insurance Carrier (if applicable) * Not Covered (Self Pay)AARPAdvicareAetnaAetna VisionAmerica’s 1st Choice MedicareAmerica’s Health PlanBlue ChoiceBlue Choice EPO (exchange)Blue Choice MedicaidBlue Cross EPO (Exchange)Blue Cross EssentialsBlue Cross of NCBlue Cross of SCBlue Cross (outside of the Carolinas)Blueview VisionBlue Cross FederalCare Improvement PlusCCN (Choice Care Network)CignaConsumers Choice Health PlanCoventry Health PlanCommunity EyecareEyeMedEyemed AccessEyemed InsightEyemed SelectFirst ChoiceFirst Health NetworkGreat West HealthcareHumanaInstil HealthMarch Vision CareMedcostMedicaidMedicareMeritain HealthMolina HealthcareMultiplanOpticareOther Insurance Not ListedPrimary Physician CareState Health PlanSuperior VisionUnited HealthcareUnited Healthcare MedicareUnited Medical Resources (UMR)Vision Care Plan (VCP)Vision Service Plan (VSP)WellcareWellpath Additional Information or Questions Number If you are human, leave this field blank. *Indicates Required Field
