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If you have an emergency, Call 911

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Are you a new patient?

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Has your insurance changed?

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Patient First Name

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Patient Last Name

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Email

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Phone Number

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I would like to receive text communications from Pediatric Ophthalmology of Erie, such as appointment confirmations, appointment reminders, and feedback requests. Message & Data rates may apply.

Insurance

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Date of Birth

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Reason for Request

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If under 18, Names of Parents/Guardians

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How Long Has the Condition/Symptom Been Present?

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Have You Had Previous Eye Surgery?

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I acknowledge that Pediatric Ophthalmology of Erie specializes in Pediatric Ophthalmology and Pediatric Optometry, we only treat medical eye conditions. We do not perform routine vision exams, (unless under the age of 5 and referred for failing a vision screening with documentation of the exam results) Appointment requests for routine exams will not be scheduled. We do not bill vision insurance for exams

If you have an emergency, Call 911