Vision Therapy Appointment Request Vision Therapy 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 AppointmentVision TherapySports VisionThis appointment form is for Vision Therapy & Neuro-Optometric Rehabilitation. For Scleral Lenses, click Here. For General Eye Care, click Here.Patient Type*New PatientReturning PatientReason 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 HH : MM AM PM NameThis field is for validation purposes and should be left unchanged.