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? CommentsThis field is for validation purposes and should be left unchanged.