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MONDAY: 7am – 5pm
TUESDAY: 9am -7pm
WEDNESDAY: 8am – 5pm
THURSDAY: 9am – 7pm
FRIDAY: 7am – 5pm
SATURDAY: 9am – 2pm
SUNDAY: CLOSED
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919-263-9163
Appointment Request
* If your vision plan is not listed, please call the office to see if your plan is in network.
First Name
*
Last Name
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Phone
*
Email
*
What is your date of birth?
*
MM slash DD slash YYYY
Time Requested
Morning Appointment
Afternoon Appointment
Evening Appointment
Which day(s) of the week do you prefer?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Do you have a doctor preference?
Yes, I do
No, give me first available
Preferred Doctor
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Dr. Lee McPherson
Dr. Samantha McPherson
Dr. Cassandria Warr
Dr. Jennifer Murphy
Dr. Kimberly Douglas
Dr. Mackenzie Dziedzic
New Patient
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What Is Your Vision Plan?
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Always Care
Community Eye Care
EyeMed
Envolve
Superior Vision Plan
Vision Service Plan (VSP)
*If your vision plan is not listed, please call the office to see if your plan is in network.
Policy Holder's Name
Policy Holder's Date of Birth
MM slash DD slash YYYY
Member ID Number
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