Tayani Eye Institute Consultation Schedule

Please use this form below to schedule a consultation or appointment, request further information, or to ask specific questions.

Schedule Your Consultation or Appointment

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*First Name:
*Last Name:
*Address:
Address 2:
*City
*State
*Zip Code
Email
*Phone:
Phone 2:
Fax:
I am interested in scheduling for the following (Check all that apply):
	Annual or Diabetic Eye Exam	Cataract Surgery
	Drooping/Non-Closing Eyelids	Follow-Up (Existing Patient)
	Eyelid Rejuvenation	Dry Eye Treatment
	Botox	Glaucoma
	Brow lift Consult	Macular Degeneration
		Schedule a consult with our Plastic Surgeon
How do you prefer to be contacted?
Questions and Comments:

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MEDICAL AND PRIVACY WARNING
Email and web page inquiries are usually reviewed within 1-2 business days. Urgent or private medical information should not be sent by email or via our web page. If you have a medical emergency, please call 911 or your local emergency medical system by telephone. Information transmitted by email or via our website may be viewed by others, and Tayani Institute cannot guarantee the privacy of any information transmitted in this way.
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Call 949-489-2218 today to schedule your consultation.