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Request An Appointment

Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.

Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!
Name
Phone*
Email*
Preferred Date*
Date Format: MM slash DD slash YYYY
Preferred Time
Nature of Visit
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Name
This field is for validation purposes and should be left unchanged.

Dr. Eric Staffier OD, P.C.

Monday: 9am – 6pm
Tuesday: 9am – 6pm
Wednesday: 9am – 6pm
Thursday: Closed
Friday: 9am – 6pm
Saturday: 9am – 5pm
Sunday: 11am – 3pm

We will do our best to accommodate your busy schedule. Request an appointment today!

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