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Introducing Text-to-Pay for Patient Billing through Weave Payment

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Home » Contact Us » Appointment Request Form

Appointment Request Form

As of June 1, 2020, our new office policy will require certain forms to be pre-filled at home and to bring the completed documentation to the scheduled appointment.

  • All patients must review his/her medical history. Medical History Form
  • All patients interested in purchasing frames must provide his/her preference to improve the optical experience. This will also better assist our staff to help select your favorite frame. Frame Questionnaire
  • Please read our Privacy Policy
  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
  • This field is for validation purposes and should be left unchanged.

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LIFETIME VISION IS BECOMING A MORE DIGITAL AND PAPERLESS OFFICE.

LETS ALL DO OUR PART TO KEEP OUR CARBON FOOTPRINT LOW!

EFFECTIVE 1/1/2024

In an effort to save the environment and improve patient experience, all patients will be automatically enrolled in paperless billing. We will NO longer be sending out paper statements unless requested by patients.

Patients will receive electronic invoices through our HIPAA compliant text.

You will be receiving a text and link from Weave Payments to pay.

Patients can pay their bills through TEXT or ONLINE on our website.

If you would like to opt out or receive paper statements, please let our front desk/administrative team know at check out.