Scleral and Hard-to-fit-Contact Lens Appointment Request Scleral Lens Appointment Request Form Please fill in the form below to request an appointment. This is only a request for an appointment, our office will contact you via text and/or email to confirm it has been scheduled Type of AppointmentScleral Lens Assessment or FittingScleral Lens Follow-upOther Custom Contact LensThis appointment form is for Scleral Contact Lenses and other specialty contact lenses. or Vision Therapy, click Here. For General Eye Care, click Here.Patient Type* New Patient Returning Patient Reason For AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email. Preferred Date and Times*Please let us know when you would prefer to have your appointment. Our hours are listed on our Contact Us page. Name* First Last Phone*Email* Best Time to be Reached for Confirmation Hours : Minutes AM PM AM/PM CommentsThis field is for validation purposes and should be left unchanged.