Flaum Eye Institute / Optical Services / Schedule a Routine Eye Exam

Schedule a Routine Eye Exam

You may use this form to request a routine eye exam with physicians at any Flaum Eye Institute Well Eye Care Center.

Request A Non-Urgent Appointment

For questions about your appointment, please contact us at (585) 273-3937 (Rochester locations) or (315) 789-4922 (Geneva location). Use this form to request a non-urgent appointment only. All requests will be processed within 24 hours during regular business hours, Monday - Friday, 8:00 am-4:30 pm. If you are experiencing an eye emergency during normal business hours, please call (585) 273-3937 (Rochester) (315) 789-4922 (Geneva).

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Contact Information

First Name

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Last Name

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Address

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City

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State

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Zip

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Year of Birth

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Home Phone Number

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Work Phone Number

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Vision Insurance Provider

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Appointment Information

Contact me between 8:00 a.m. and 4:30 p.m. via:

Home Phone Work Phone Email

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Do you wear contact lenses or prescription glasses?

Yes No

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Please select location

Strong Memorial Hospital (210 Crittenden Blvd.) College Town (1317 Mt. Hope Ave.) Geneva (738 Pre Emption Rd.) Batavia (45 Liberty St.) Brighton (1701 Lac De Ville Blvd.) Webster (875 Hard Rd.) Pittsford (160 Office Parkway) Rochester S. Clinton (500 S. Clinton Ave.) Geneseo (48 East South St.)

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Please indicate your first choice for day and time.

Day of week

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Time of day

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Please indicate your second choice for day and time.

Day of week

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Time of day

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Do you require an interpreter?

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