Online Appointment Request Form

Name: Triangle Family Eye Care
Address: 1216 Village Market Place, Morrisville, NC, 27560, US
Telephone: 919-459-5995

If this is an emergency, do not contact us via email, please call 911 or go to the nearest emergency room.

Please note this is an appointment request, our online scheduler will be contacting you to confirm this request within 24 hrs. You are not booking an appointment by submitting this request.
Patient Type*
- New Patient
- Established Patient
Name*
First Last
Phone Number*
Email*
Reason for Appointment*
- Routine Exam (interested in contact lenses)
- Routine Exam (not interested contact lenses)
- Medical Office Visit (redness, pain, injury. etc)
- Dry Eye Evaluation (chronic issue)
Vision Insurance Provider*
Medical Insurance Provider*
Preferred Dates and Times
Please note we do not schedule appointments between 1:00 - 2:00 PM.
Please check your preferred time:*
- MORNING
- AFTERNOON
Comments
Please provide if you are currently wearing glasses or contact lenses and what brand of lenses your in.
Cancellation Policy
Triangle Family Eye Care will assess a fee of $35 for anyone who schedules an appointment and fails to give our office a 48 hour cancellation notice. The same fee will be assessed for any no show appointments.
Retinal Imaging
If you are scheduled for a Routine Eye Exam, Retinal Imaging is required. Please call with any questions or concerns.
Comments
This field is for validation purposes and should be left unchanged.

Preferred Dates and Times