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Appointments

If you would like to schedule an appointment, please complete the fields below and someone from our office will contact you to confirm your appointment details.

Required information:
Title:
First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip:
Phone (day):
Phone (evening):
Best time to call:

Optional, but helpful information:
Reason for Appointment:
I am available for an appointment on:
Please do not request a "same day appointment" via this website.
Your Optometrist:
Preferred doctor:
Preferred location:
Type of insurance:

What should the doctor know about you?

This is not a secure contact form. Please do not include sensitive medical information in your appointment request that you would not normally feel comfortable sending over email.

By using this form you are submitting a request only. Until you receive either an e-mail from one of our schedulers or a telephone call, you do not have an actual appointment. Thanks for your understanding.
  

VISIT US AT: 801 S. Chevy Chase Dr., Suite 103 Glendale, CA 91205-4437
PH: 818-265-2255 / Fax: 818-507-5027
EMAIL: services@lugeneeye.com

Medical Services :: Eye Conditions :: Doctors :: Why Choose Us? :: Patient Forms :: Procedures
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