To schedule an appointment, complete the form below. You will be contacted within two business days with an appointment date and time. Please do not use this form for emergencies or questions.

Attention New Patients: Click here for information about your visit.
Required Patient Information:
Today's Date
Patient Name
Date of Birth
Address
Were you referred? By Whom
Reason for visit

  

     
 
Select a Physician by location

Middletown
Mon 8:30am - 6:30pm
Tue, Wed, Thu, Fri 9am - 5pm
   
First Available
Dr. Schwartz
Dr. Rocco
Dr. Luskind
Dr. Shriver
Dr. Mulukutla
Dr. Segal
Dr. Gorin 
 
 
 

Clinton
 Tue & Thu 9am - 4:30pm
    
First Available
Dr. Schwartz
Dr. Shriver
Dr. Mulukutla
 
 
  
  
   

Marlborough
Wed 9am - 11:30am
    

    
Dr. Luskind

   
   
   
  
   
 
When are you available? (please provide up to three options)
 

Day of the Week

or  Specific Date

 Time of Day  
1.  
2.  
3.  
 
How can we best contact you?
Daytime phone
Email address
INSURANCE
Please review our insurance procedures (remember to check eye coverage)
  1. Check with your insurance carrier prior to the appointment
    to confirm that services will be covered.     The phone number to check coverage is on your insurance card.
  2. You are responsible for obtaining a referral, if required by your plan.
  3. Co-pay is expected at time of visit.
 
Thank you for taking the time to fill out this form. Having this information will assist us in preparing for your appointment..

 

If you have any questions,
call our main office at (860) 347 - 7466

 
     
 

for all your eye care needs

  
 
   

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400 Saybrook Road
Middletown, CT 06457
(860) 347-7466
(860) 347-8300 (Optical Dept)

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