In Focus Online Consultation Request

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Online Consultations are best for:
- Patients based outside of Arizona who are considering travel for specialty contact lens solutions
- Patients who are interested in knowing about their options and suggestions for application with local Doctors.

Estimated time to complete form: 5 - 10 minutes
Medical records will be requested prior to consultation.

Disclaimer: Dr. Morrison may not be able to provide diagnosis, provide prescriptions, or design contact lenses without an in-person visit. Phone consultations are recommended for those who are considering travel for treatment and want to understand their current options for vision correction.

E-mailadres *

First name *

Last name *

Best phone number to reach you: *

Best time of day to reach you by phone: *

9 am - noon PST

noon - 5 pm PST

Anders:

Tell us about the reasons you’d like an consultation via zoom. *

Tell us about your vision goals - where do you want your vision to be? *

I understand I will be charged $150 for an online consultation via Zoom with Dr. Morrison. *

Once we receive medical records, we will schedule your online consultation. If you have questions about this charge, please email info@youreyesinfocus.com.

I understand and agree to the phone consulation fee.

Verplicht

DISCLAIMER: This virtual care visit request, subsequent virtual care email invite and any attachment(s) is/are for authorized use by the intended recipient(s) only and must not be read, distributed, disclosed, used or copied by anyone else. If you are not the intended recipient, please notify the sender immediately, disconnect and delete any attachment(s). Patients may be re-directed to the clinic for an in-person visit at any time if the concern is deemed not appropriate for virtual care. This virtual visit is based on history, treatment, and scans provided by outside Doctors. Dr. Morrison will not be able to provide diagnosis, provide prescriptions, or design contact lenses without an in-person visit. *

I have read the following disclaimer and I agree to submit my request for an online consulation. By accepting yes, I am authorizing a telehealth consultation via zoom with Dr. Morrison, and I acknowledge I will be called to schedule as soon as possible.

Verplicht

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