Request an Appointment with Eye Candy's Vision Specialist, R. Anthony Rabbani, O.D.

To request a vision appoinment at Eye Candy Optometry, please complete and submit this form. We will telephone you soon with some convenient appointment times based on your preferences and needs.

Personal Info

Full Name:

Telephone:

Email Address:

Gender:

Guy Girl Dude Chic Gentleman Lady Male Female Don't Ask

Date of Birth:

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950

Appointment Request Details

Which Hours Generally Work Best for You?

9am-11am 11am-2pm 2pm-5pm 5pm-8pm

Do you have vision insurance?

Yes No I'm not sure

If using insurance, please indicate the insurance company's name:

Please enter the reason for your visit and/or comments.