Patient Appointment Request

At Park Avenue Optometry, we provide the highest quality service to all our patients. Use the form below to request your appointment or to refer a patient. Please indicate preferred date and time. Please note that we will reach out to you first to confirm the appointment or to provide you with an alternative date. You may also call us to request an appointment. Thank you!​​​​​​​

Upload insurance card or insurance authorization:

This section is for the person referring only:

Are you frequently referring pediatrician?

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