appointment request Name * First Name Last Name Phone * (###) ### #### Email * Preferred Method of Contact * Phone Email Reason for Exam * Comprehensive Eye Exam Comprehensive Eye Exam + Contact Lens Fitting Medical Visit (Red Eye, Irritated Eyes, Vision Loss, Pain) Other (specify in notes below) Day of Week Preference * Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Saturday AM Saturday PM First Available Location Preference * Fullerton (1909 W. Malvern Ave, Fullerton, CA) Orange (850 E. Chapman Ave Suite B, Orange CA) Anaheim Hills (6200 E Canyon Rim Rd Suite 101, Anaheim, CA) Doctor Preference * Dr. Alvin Arellano Dr. Gregory Char (Orange location only) Dr. Chris Hsieh Dr. Neda Nilieh Dr. Cynthia Nguyen (Orange location only) Dr. Thu Phan First Available Vision Insurance? * Yes - VSP Yes - EyeMed Yes - Spectera Yes - Davis Vision No - Private Pay Unknown/Unsure Unlisted Anything else you'd like us to know can go here: Thank you! We will process your submission within 1 business day and contact you shortly.