Sample Scheduler

Select Location
Select Service & Provider
New Patient - Comprehensive Exam
Description:
Add your own customizable description
Add your own customizable description
Established Patient - Comprehensive Exam
Description:
Add your own customizable description
Add your own customizable description
New Patient - Contact Lens Exam
Description:
Add your own customizable description
Add your own customizable description
Established Patient - Contact Lens Exam
Description:
Add your own customizable description
Add your own customizable description
Medical Office Visit
Description:
Red Eye, Eye Pain, Floaters, etc.
Red Eye, Eye Pain, Floaters, etc.
Glasses Pick Up
Eyewear Fitting
Selection Required
- Dr. Bugs Bunny
- Dr. Jane Doe
- Dr. John Smith
- Optical
- Test Test
- Any Available Provider
This area can be fully customized to convey information patients would need to know while scheduling.
HTML coding can be used to make text stand out more. You can make font Bold, different colors, BIGGER, etc.
For Example: If you do not see an available appointment, please call our office at XXX-XXX-XXXX.
Select Appointment Time
This area can be fully customized to convey information patients would need to know while scheduling.
HTML coding can be used to make text stand out more. You can make font Bold, different colors, BIGGER, etc.
For Example: If you do not see an available appointment, please call our office at XXX-XXX-XXXX.
Fill In Your Information
Fields marked with * are required
**This area can be customized to convey important information to the patient regarding insurances.**
Full First Name - No Nicknames or Spaces
MM/DD/YYYY
/
/
Start with area code
-
-
Confirmation and Pre-Exam instructions will be sent here
Do not close this window
Please wait... your appointment is being submitted.
Please wait... your appointment is being submitted.
Powered By
ScheduleYourExam.com
|