new appointment form test Appointment Request Form - Manhattan Office Name First Last Date of Birth MM slash DD slash YYYY Phone number Email New or Returning Patient* New Patient Returning Patient The purpose of my appointment Contact Lens Evaluation/Fitting Eyeglasses Evaluation Dilated Retinal Examination Dry Eye Evaluation/Treatment Update Eyewear Other Reason for other I would like an appointment withSelectSusan Resnick, O.D.Jordan Kassalow, O.D.Kevin Rosin, O.D.Caryn Nearnberg, O.D.Optical only*Note availability Susan Resnick, O.D. Tuesday 8:00 am - 12:40 pm; 3:30 pm - 6:00 pm Thursday 8:00 am - 12:40 pm; 3:30 am - 6:00 pm Jordan Kassalow, O.D. Monday 9:20 am - 1:00 pm; 3:00 pm - 6:00 pm Wednesday 8:00 am - 12:40 pm; 3:30 pm - 6:00 pm Friday 8:00 am - 1:30 pm Kevin Rosin, O.D. Tuesday 8:10 am - 1:00 pm; 3:30 pm - 6:00 pm Wednesday 8:10 am - 1:00 pm; 3:30 pm - 6:00 pm Thursday 8:10 am -1:40 pm Friday 8:10 am - 1:40 pm Caryn Nearnberg, O.D. Monday 11:30 am - 5:00 pm Tuesday 8:00 am - 12:40 pm; 3:30 pm - 6:00 pm Wednesday 2:00 pm - 6:00 pm / Alternate Thursday 8:00 am -12:40 pm; 3:30 pm - 6:00 pm Friday 11:30 am - 5:00 pm Saturday 9:00 am - 1:30 pm / Alternate The Optical is open Monday - Friday Please select 3 appointment dates/times. If you require immediate assistance, please call our Manhattan office at 212-355-51451st Choice MM slash DD slash YYYY Time 2nd Choice MM slash DD slash YYYY Time 3rd Choice MM slash DD slash YYYY Time All patients should bring all eyeglasses to their appointment. All contact lens wearers should arrive at their appointment wearing their contact lenses. * Please note - The requested appointment time (s) may not be available. We will contact you to confirm your actual appointment date and time. Appointment Request Form - Roslyn Office Name First Last Date of Birth MM slash DD slash YYYY Phone number Email New or Returning Patient* New Patient Returning Patient The purpose of my appointment Contact Lens Evaluation/Fitting Eyeglasses Evaluation Dilated Retinal Examination Dry Eye Evaluation/Treatment Update Eyewear Other Reason for other I would like an appointment withSelectSusan Resnick, O.D.Kevin Rosin, O.D.Optical onlyNote Availability: Susan Resnick, O.D.: Wednesday 12:30 pm - 5:30 pm Friday 8:00 am - 1:00 pm Saturday 8:00 am - 12:40 pm Kevin Rosin, OD: Monday 10:20 am - 1:00 pm; 3:00 pm - 6:00 pm Optical Open Monday, Wednesday, Thursday, Friday and SaturdayPlease select 3 appointment dates/times. If you require immediate assistance, please call our Roslyn office at 516-365-45001st Choice MM slash DD slash YYYY Time 2nd Choice MM slash DD slash YYYY Time 3rd Choice MM slash DD slash YYYY Time All patients should bring all eyeglasses to their appointment. All contact lens wearers should arrive at their appointment wearing their contact lenses. * Please note - The requested appointment time (s) may not be available. We will contact you to confirm your actual appointment date and time.HiddenUntitledFirst ChoiceSecond ChoiceThird ChoiceHiddenUntitled First Choice Second Choice Third Choice
Hours may be subject to change without notice.