Please check all that apply. **PLEASE NOTE: If this is an urgent visit, we recommend contacting our office by calling or texting 770-917-2221. Response to requests may take 48-72 hours.

Please let us know what day(s) and time(s) you would prefer to have your appointment. THIS IS NOT A GUARANTEE OF YOUR APPOINTMENT UNTIL OUR STAFF CONTACTS YOU AND CONFIRMS IT BY PHONE, TEXT OR EMAIL. Please be aware that our reminders are just a courtesy, and it is ultimately the responsibility of the patient/guardian to note the appointment date and time. Please read our APPOINTMENT POLICY on cancellation, rescheduling, and no shows.

Please let us know if you are a new or existing patient. For FOR NEW PATIENTS, in order to be seen at our clinic and prevent appointment cancellation, you must complete the online form BEFORE the appointment.

Insurance appointments may take up to 3-5 business days for verification. We will contact you by phone, text or e-mail if we cannot confirm your insurance. Please click on the following link to confirm the insurances that we accept. Insurance must be verified and eligible before the appointment is made.

PLEASE NOTE: If you prefer a faster response, please allow our office to communicate by text. Texts are are unencrypted and subject to charges/fees by your carrier that are paid by subscriber. PLEASE REMOVE ANY TEXT BLOCKING OR YOU WILL NOT RECEIVE TEXTS. Email info@miraeye.com if you have not received a text within 3 business days.

You are required to read the Health Policy Protocol. For FOR NEW PATIENTS, in order to be seen at our clinic, you must complete the online paperwork BEFORE the appointment. Please check Yes or No if you agree to the requirements. If you check No, we will not be able to schedule you for the foreseeable future.