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Online Patient Registration Form

lock icon Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office. This form contains confidential information and is delivered to your doctor through a secure Internet connection.

CORONA VIRUS UPDATE

We are here to take your calls but office doors are closed for patient entry.

Please click here to read the Doctor's message on the Corona Virus outbreak.

Patients can pick up their glasses and contacts in the back parking lot.

If you need to refill a prescription medication, Dr Parker is available

We are taking names and phone numbers for those who want to schedule when we reopen.

If patients want to reorder their contacts or even their glasses we are here to take their orders.