UC Berkeley Optometry Clinic Inquiry
Please DO NOT SUBMIT MULTIPLE FORMS -complete the form below and we will respond to your inquiry within 2-3 days.
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Email *
Last and First name *
Phone Number *
Are you an existing patient?
Clear selection
How can we assist you?
Please choose desired department
For appointments-select preferred day of the week
For appointments-select preferred appointment start time range
For appointments-indicate preferred dates
Please select your VISION insurance carrier:
If you answered Other for VISION Insurance please list your carrier.
Please provide your MEDICAL insurance carrier.
Submit
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