Oh dear..
It looks like we were unable to load the form.
You might like to try:
Refreshing the page
Checking your network connection
Using a different browser
Checking your browser settings and extensions
Loading the page in an incognito window
Contacting
Paperform Support
Ava Appointment Request
Full Name
This question is required
Phone Number
This question is required
E-Mail
Please enter a valid email
Do You Wear Contacts
Yes
No
This question is required
Are you diabetic?
Yes
No
This question is required
Do you have medical or vision insurance?
Medical
Vision
Both
Neither
This question is required
Desired Appointment Date
/
/
Please enter a valid date
Desired Appointment Time
:
PM
Please enter a valid time
Submit
✕
Powered By Paperform