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Home » Contact Us » Appointment Request Form

Appointment Request Form

  • 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.
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  • This field is for validation purposes and should be left unchanged.
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Our office will run on limited hours during the month of April at our temporary location. No patient examinations will be scheduled but we can provide you assess to your RX, order contact lenses, warranty on eyeglasses.

Any issues please contact us at 602.237.4777, email: laveentotaleyecare@gmail.com. We will get back to you ASAP.

Be Safe!!