Request an Appointment

To request an appointment at Associated Eye Surgery Center, fill out the form below and click “Send Request.” We will contact you to schedule the appointment.

*Please note: This request form is not intended as a tool for reporting a medical emergency or medical problem. It will not go to a physician and is only monitored during normal business hours. If you have critical or timely information, please contact a physician directly. If you have a medical emergency, please call 911.