Privacy & HIPAA

New Patient Packet

Online Appointment Request

For Non-Emergency Appointments

You may request a NON-EMERGENCY appointment online using the following form. An associate in the office will review your request and respondvia e-mail informing you of available appointment days and times that best fit your needs as indicated. Please respond to that e-mail with your desired date and time, which will then be verified with you by the front desk, by e-mail or phone.
Appointments online will be set a minimum of three (3) business days ahead. You will be called and reminded of your appointment the business day before your appointment.
Bohn and Joseph Eye Center only gathers the minimal amount of personal data, voluntarily submitted by the patient, necessary to complete the desired task.
If your insurance company requires prior authorization, you are responsible for contacting your primary care physician to receive this authorization prior to your appointment at Bohn and Joseph Eye Center.

Notice: Bohn and Joseph Eye Center recommends contacting the office directly for any appointments other than routine exams, if you have a particular date preference, or need any special arrangements.

Cancellations: Should you be unable to keep an appointment after it is scheduled, please inform our office at least 24 hours in advance so that we may give your appointment to another patient. Rarely, emergency surgery may require us to reschedule your appointment.

Phone: 337-981-6430
Toll Free: 800-543-3798

First Name

Last Name

Address

City

State

Zip Code

Birth Date (DD/MM/YYYY)

Phone Number

Email Address

Have you come to Bohn & Joseph Eye Center before?:

  Yes
  No
  Don`t Remember

Which doctor do you prefer?:

  Dr. Bohn
  Dr. Joseph
  Dr. Swan
  No Preference

NOTICE: The physicians in this office do not participate in vision plans. Please refer to your benefit book to determine what services your insurance company will or will not pay for.

What is your appointment concerning?:

  Complete Eye Exam
  Contact Lens Fitting
  Glaucoma Check (gDx)
  Visual Field
  Revisit
  Other

Which day would you prefer?:

  First Available
  Monday
  Tuesday
  Wednesday
  Thursday
  Friday

Would you prefer your appointment in the morning or afternoon?:

  Morning
  Afternoon
  First Available

Do you wear glasses or contacts?:

  Glasses
  Contacts
  Both Contacts and Glasses
  Neither
  Have glasses/contacts but do not wear

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Items in RED are required.

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