South Grove Eye Care
                            Quality eye care for you and your family
 
 
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*Cataract Referral and Post-op
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SCHEDULE A VISIT
 
To schedule a visit with Dr. Harvey or Dr. Hoffman, complete the form below.  After you have entered all the information, click the "Request an Appointment" button to send your request.
 

   1.  Select an optometrist

   Dr. Hoffman       Dr. Harvey      Either optometrist

   2.  Patient Name:    

                                  I am a new patient

   3.  Guardians Name:

   4.  Contact Information:

         Phone Number:         
         Email Address:  

   5.  Request a date and time for your appointment:

        First Choice (month/day/year: time): 

        Second Choice (month/day/year: time): 

                                                                    

 
South Grove Eye Care complies with HIPPA and HICA.  You can print and complete the Patient Medical History Form, and the Patient Contact-Privacy Form to bring with you to your visit.
 
 
 

South Grove Eye Care … 2020 S. State Road 135, Suite 200 … Greenwood, IN  46143 … 317.535.3935