Appointment Request Form Do not use this form for any emergency or urgent eye care request. If you are in an emergency, please call our practice.Select a Location* 150 East Manning Street, Providence, RI 1525 Wampanoag Trail, East Providence, RI 55 Village Square Drive, South Kingstown, RI 235 Hanover Street, #201, Fall River, MA Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred Date & Times*Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.Patient Type* New patient Returning patient Please let us know if you are a new or existing patient.Name* First Last Phone*Email* Best Time to be Reached for Confirmation* : Hours Minutes AM PM AM/PM CommentsPhoneThis field is for validation purposes and should be left unchanged.
