Searcy Eye Care Center
 
Confirm you examination appointment here. This information will be e-mailed to our office staff. No information, including your Email address, will be released to third parties. Please download a medical history form to help with your examination. Please print, fill out and bring with you to your examination. Download/Print Medical History Form - pdf

    Your Email Address (Required):

    Your Name (Required):

    I am confirming my appointment for: Appointment Day:

    Date: Month Day Year

     

    Concerning my appointment:

    Yes, I will be there I need to reschedule (enter more information below)  Other 

    At my exam, I want more information about:

    Contact lenses  Tinted lenses  Ortho-K  Refractive Surgery  Other

    Question/Comment: