Your Name*Telephone Number (We'll call you to confirm!)*Address*Email Address* What Day Would You Like an Appointment?What Time Would You Like an Appointment?Have You Ever Had an Exam with Dr. Tarr or Dr. Yates Before? Yes No Are you a diabetic or borderline diabetic? Yes No What Vision Insurance Do You Have?What Medical Insurance Do You Have?EmailThis field is for validation purposes and should be left unchanged.
