Appointment Request Form Please fill in the form below to setup an appointment.During your exam, would you be interested in learning if myopia management can benefit your child? Yes Not at this time Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred Date & Times*Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.Patient Type* New patient Returning patient Please let us know if you are a new or existing patient.This exam is for* A child An adult Our practice specializes in Myopia Management for children. Nearsightedness / myopia is one of the leading causes of eye disease in adults, but myopia management can slow down myopic progression in your child and help prevent glaucoma, macular degeneration, etc. If you haven't heard about myopia management, please click here here to learn more about it. If it is relevant for your child, our eye doctor will introduce you to myopia management at the eye exam. Feel free to contact us at 225-769-6010 before your child's eye exam to learn more about this service or browse our website for further information.Name* First Last Phone*Email* Best Time to be Reached for Confirmation* : Hours Minutes AM PM CommentsCAPTCHANameThis field is for validation purposes and should be left unchanged.