Skip to main content

In the center of Glastonbury on Hebron Ave Near Scissor Kids & Whole Foods.
Call Us 860-724-2022 Schedule Eye Exam Online

Home » Our Practice » Contact Us » Patient Registration Form

Patient Registration Form

Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office.



This form contains confidential information and is delivered to your doctor through a secure Internet connection.

x

Our office will be closed on the following Saturdays during the summer: May 25, June 8 and 22, July 6 and 20 and August 3, 17, and 31. From our family to yours, Happy Summer!