Skip to main content
Menu

Distinction in Eyewear and Eyecare

Request An Appointment
Call Now! 717-356-3561
Home » Contact Us » Appointment Request Form

Appointment Request Form

New Patient Appt Request Form

  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

We recommend all new patients download & print the forms below. You can fill them out at your convenience to make your appointment at our practice quick & easy!

New Patient Intake Form

New Patient Registration Form

Returning Patient Appt Request Form

Schedule Your Next Visit Through Your Personal Health Record

Thank you for your interest in scheduling an appointment with our office. We invite you to schedule your appointment from your secure Personal Health Record (PHR).

If we’ve seen you before and you have forgotten your username and/or password, please call our office at 717- 354-2020 and we’d be happy to help. Once inside your PHR, you’ll be able to search for and schedule your visit.

If you are experiencing an eye emergency, please call our office immediately at 717-354-2020.

I'm A Returning Patient

Video

Optometric Associates, New Holland, Pa. from David D. Speace on Vimeo.