Appointment Request Form

You can make an appointment on-line here, or you can call us at 707-527-9137. We will contact you either by phone or email to confirm your appointment. Appointments are scheduled Monday through Friday from 8:30 am to 5:00 p.m. We do have a limited number of Evening and Saturday appointments available. If you experience any difficulty with this form please send e-mail to Dr. Hollis Stavn.

Enter your name

E-Mail address Age(of person to be examined)

Phone-day Phone-evening

Address City Zipcode

I am a current patient new patient

This exam would be for an adult a child

I would like an appointment This week Next Week Two Weeks

I would like an appointment on Monday Tuesday Wednesday Thursday Friday Saturday

I would like an appointment in the morning afternoon

I prefer time 9 am 10 am 11 am 1 pm 2 pm 3 pm 4 pm 5 pm other

I am interested in an exam for Routine/Glasses Contact Lenses Laser Surgery Evaluation Eye Health Concerns Vision Therapy

If you have any questions or would like to provide more information you may do that here.

Thank you !

I would prefer confirmation by e-mail by phone

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