First Name
Last Name
Daytime Phone Number
Email Address
Preferred Day
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Preferred Time
8:00am - Available Saturday Only
8:30am - Available Saturday Only
9:00am - Available Saturday Only
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm - Not Available Saturday
2:00pm - Not Available Saturday
2:30pm - Not Available Saturday
3:00pm - Not Available Saturday
3:30pm - Not Available Saturday
4:00pm - Not Available Saturday
4:30pm - Not Available Saturday
5:00pm - Not Available Saturday
Reason For Visit
ROUTINE EYE EXAM
CONTACT LENS EXAM
OTHER
Insurance
AETNA
FIRST CHOICE HEALTH NETWORK
LIFEWISE HEALTH PLAN OF WASHINGTON
PREMERA BLUECROSS
REGENCE BLUESHEILD
OTHER
Additional Information
7101 MARTIN LUTHER KING JR WAY S, STE 209
SEATTLE, WA 98118
TEL | 206.722.2218
FAX | 206.722.2211
