Request an Eye Exam (This form is for NON-emergencies only. Please do not use this form if you are experiencing an eye injury or other eye health complication. Instead, please call our offices at 205.979.2020.)


Name:
Date of Birth:
Address:
Email:
Phone:
 
New Patient? Click here for New Patient Form
New or Existing Patient:
 
Reason for Appointment:
 
Day:
  1. Day
    Time of Day

  2. Day
    Time of Day

  3. Day
    Time of Day
 
Preferred office:
 

After submission, Schaeffer First Team will go through all appointments and find the appointment that best suits your request. SFT will contact you via best available daytime phone number to give you a confirmation for the best available appointment. Please wait until you have a confirmation, or you can call any of our 15 offices to set an appointment.