Name
Address
Age
Date of Birth
Gender
Male
Female
Other
Home Phone
Work Phone
Cell Phone
Email
Best way to contact
Home
Work
Cell
Email
Best time to contact
Anytime
A.M.
P.M.
Appointment Information
Note: Indication of time and date preference is not a guarantee for an appointment time. Times and dates for appointments may differ based upon doctor and specialty.
Appointment Request Type
Request a Doctor’s Appointment
Request an Optical Shop Appointment
Appointment Type
Annual Exam
Follow-Up
LASIK Consultation
Consult
Corneal Cross-Linking
Other
Office Location
Albuquerque - East 25 Way
Albuquerque - Northside
Albuquerque - Promenade
Albuquerque - Retina Center
Farmington
Los Alamos
Los Lunas
Rio Rancho
Roswell
Santa Fe
Southside Santa Fe
Please Specify Doctor Appointment Type
Optical Appointment Type
New Glasses Order
Pick Up and Existing Order
Repair/Adjustment
Other
Optical Office Location
Albuquerque – Northside
Albuquerque – Promenade
Albuquerque – Regina Hall
Farmington
Los Alamos
Los Lunas
Rio Rancho
Roswell
Santa Fe
Southside Santa Fe
Please Specify Optical Appointment Type
Select Doctor
Arthur J. Weinstein, MD
Rebekah C. Allen, MD
Chris Buntrock, MD
Angela R. Bratton, MD
Arlene Bagga, MD
Christine Clavell, MD
Iuri S. Golubev, MD
Gavin Gorrell, MD
Kenneth D. Himmel, MD
Mark P. Lesher, MD
Renny H. Levy, MD
Barbara C. Marsh, MD
Gregory S.H., Ogawa, MD
John D. Pitcher, III, MD
Kamalesh J. Ramaiya, MD
Ashok K. Reddy, MD
Kristin E. Reidy, DO
Molly E. Ritsema, MD
Mahlon R. Soloway, MD
P. James Sanchez, MD
Rizwan A. Shaikh, MD
Ian A. Thompson, MD, MPH
Craig R. Vroman, MD
Amanda D. Achilles, OD
Aaron J. Andzelik, OD
Matthew H. Armentrout, OD
Nina Ballew, OD
Ellen M. Beebe, OD
Erika L. Anderson, OD, FAAO
Erin C. Byrne, OD
Rebecca J. Callahan, OD MBA
Melinda Cano Howes, OD
Davis Capaccioli, OD
Julia Coulter, OD
Jamie Dunn, OD
Devan Fillmore, OD
Hope Hanrahan, OD
A.J. Javid, OD
Timothy J. Johnson, OD
Suchitra Katiyar, OD
Julie E. Kleva, OD
Jason C. Koschmeder, OD
Stephanie R. Loftus, OD
Kelly E. Morgese, OD, MPH
Nicholas B. Ritz, OD, FAAO
Richard Saiz, OD
Damian Solano, OD
Catherine A. Uher, OD
Referring Doctor
Spanish speaking only
Yes
No
*Appointment Date must be at least 2 business days from today. We will do our best to match the date/time to accommodate your request.
Insurance Information
Member ID
Group Number
Insurance Name
Insurance Address
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua & Deps
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherland
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St Kitts & Nevis
St Lucia
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Other
Comments or Questions
Text message reminders
Yes, I would like to receive text messages for appointment reminders
Verification
SUBMIT