www.memorialeye.com

Laser Vision Correction

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Appointments

If you would like to schedule an appointment, please complete the fields below and someone from our office will contact you to confirm your appointment details.

If you have questions regarding scheduling an appointment please contact us at (717) 657-2020 or toll-free at (800) 382-2020, or click here to send us an email.

Required information:
Title:
First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip:
Phone (day):
Phone (evening):
Best time to call:
Optional, but helpful information:
Reason for Appointment:
I am available for an appointment on:		Please do not request a "same day appointment" via this website.
Your Optometrist:
Preferred doctor:
Preferred location:
Type of insurance:
What should the doctor know about you? This is not a secure contact form. Please do not include sensitive medical information in your appointment request that you would not normally feel comfortable sending over email.
By using this form you are submitting a request only. Until you receive either an e-mail from one of our schedulers or a telephone call, you do not have an actual appointment. Thanks for your understanding.

2 Locations to Serve You:

Harrisburg Location: 4100 Linglestown Road, Harrisburg, PA 17112
Phone: (717) 657-2020 | (800) 382-2020 | Fax: (717) 657-2071
Click Here to E-mail Us

West Shore Location: 4407 Carlisle Pike • Camp Hill, PA 17011
Phone: (717) 975-2015 | Fax: (717) 657-2071

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Appointments

Required information:

Optional, but helpful information: