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November 2011
We have great news! The Atlantic Station Eye Gallery has moved to a brand new home conveniently located between Publix and Kilwins. We are now in the heart of Atlantic Station - walking distance to some of the area's best shopping destinations.


Holiday Season
The Eye Gallery is gearing up to offer you the best selection of eyewear for the upcoming holiday season. Stop by any location and preview the latest styles from the top name brands in fashion eyewear. Remember, sunglasses make perfect holidays gifts. We also have gift certificates available for your special someone.


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PATIENT INFORMATION

Patients Full Name:
if patient is under the age of 18 parent or guardian name is needed.
Parent /Guardian Name: Age:
Contact Phone #:
E-mail:
Location:
For same day appointments please call store.
  
Previous patient?  
Do you currently wear prescription glasses?  
Do you currently wear contact lenses?  
Exam for:

APPOINTMENT DATE AND TIME*

1st CHOICE:
2st CHOICE:

INSURANCE INFORMATION
Insurance Provider:
Member ID #:
Member's Name:
(If different than patient's name)
Date of Birth:

* We can only accommodate same day appointments by phone. The on-line appointment option of our website is for routine appointments ONLY and NOT emergencies.


EMERGENCY CONTACT INFORMATION
If you are experiencing a significant problem/medical eye emergency (loss of vision, sudden change of vision, unusual eye pain, eye trauma, fainting or dizziness) call a store location immediately!


AFTER HOURS (call our affiliate):
OMNI EYE SERVICES - 404.257.0814

Omni has a 24/7 answering service with a doctor on call.


NOTE: Patients CANNOT call Omni for replacement contacts or prescription eyeglasses, strictly medical emergencies. If conditions worsen and become severe call 911.

DURING BUSINESS HOURS: CONTACT STORE