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Please use this form to ask questions or comment on our services. You may also compliment us with your inspiring testimonial about your experience at Beach Eye Care for inclusion on the website. If you do have questions, a member of our vision correction team will get in touch with you as soon as possible with more information.

Hours

First Colonial		Holland Road		Red Mill
Monday	8-5	Monday	CLOSED *	Monday	11-5
				(OPEN for pickups only)
Tuesday	8-5	Tuesday	8-5	Tuesday	8-5
Wednesday	8-5	Wednesday	11-8	Wednesday	8-5
		(CLOSED from 8-11 ...not open for pickups)
Thursday	8-8	Thursday	8-5	Thursday	8-5
Friday	8-5	Friday	8-5	Friday	CLOSED
Saturday	8-2	Saturday	8-2 **	Saturday	8-2 **

Starting February 2012:
* Office open 4th Monday of every month.
** Office closed 4th Saturday of every month.

Normal hours of operation are listed above. Hours of operation are subject to change.
Please call 757.425.5550 to confirm.

Fill out this form or call (757) 425.5550

Welcome to the Beach Eye Care Appointment Request Form! This form is designed to streamline your request for an appointment via email.
	* Denotes required information
Preferred Practice Location: *	1201 First Colonial Road 2173 Upton Drive (Red Mill) 4388 Holland Road Please choose a location.
This site should not be used for urgent matters. For eye emergencies during normal hours of operation (see above), please call our office at 425-5550 and our staff will assist you. For eye emergencies occurring outside normal hours of operation, please call our office at 425-5550 and select the on-call doctor option from the automated greeting. NEW PATIENTS: After submission of this form, expect a call to obtain additional information that is necessary for new patient scheduling.

Contact Information Please provide the following information so that we may contact you to schedule your appointment for a visit. This form will not automatically schedule your appointment, you will receive an e-mail from our office confirming your appointment date and time.
Last Name: *	Please provide your Last Name.
First Name: *	Please provide your First Name.
Phone Number:
Email Address: *	Please provide a vaild email address.
Verify Email Address: *	Please provide a vaild email address.
I am interested in: *	Please tell us what you're interested in.

Insurance Information
I am: *	Please tell us your Patient Status
My Insurance Provider is: *	Please include your Insurance Provider
Other - Write In	Please include your Insurance Provider.
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My Vision Plan is: *	Please include your Vision Plan Provider
Other - Write In	Please include your Vision Plan.
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I heard about Beach Eye Care through: *	Please tell us how you heard about us.

Appointment Preference

Make your request as early as possible to receive your preferred date and time.

Please note, Beach Eye Care is not open on Sundays.

Choose from the options below:
First Available or Select My Date and Time
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You may select multiple days and times.

First Date Choice

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Second Date Choice

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Third Date Choice

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Additional comments to assist us in meeting your scheduling needs. You may specify your availability regarding dates and times. No medical questions, please.

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Location: .
Last Name: .	First Name: .	Phone Number: .
Email: .	Repeat Email: .
Interests: .	Patient Status: .
Insurance Provider: . .	Insurance Policy ID: .
Vision Plan: . .	Vision Plan Policy ID: .
I heard about Beach Eye Care through: .

Appointment Preference

Appointment Choice: .

Comments: .

First Date Choice: .
Second Date Choice: .
Third Date Choice: .

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Beach Eye Care Accepts Most Health Insurance Plans

A few of the major providers are listed below. Click here to see a full list or call us for more details.

AARP
Aetna
Anthem
Anthem Healthkeepers
Avesis Vision
Blue Cross Blue Shield
Cigna

Coventry
Davis Vision
EyeMed
GEHA
GHI
Golden Rule
Great West

Hartford Life
Humana
Mail Handlers
Mamsi (under UHC)
Medicaid
Medicare
Medicare Railroad

Mutual of Omaha
Optima
Prudential
Superior Vision
Today's Options
Tricare Tricare Prime
United Healthcare

USAA
VA Health Network
VA Premier
Vision Benefits of America
VSP Eye Care

Hours

Fill out this form or call (757) 425.5550

Welcome to the Beach Eye Care Appointment Request Form!

Contact Information

Insurance Information

Appointment Preference

Preview

Appointment Preference

Beach Eye Care Accepts Most Health Insurance Plans