Request an Appointment

Request an Appointment
  • To request your next appointment, complete the form below and let us know the most convenient time and date for you. Please do not forget to include accurate contact information so we can follow up with you to finalize your request.
    Appointment requests may be sent to your practitioner using regular email, so please do not enter any confidential information on this form.
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  • Patient Information
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  • I am a...*
    New Patient
    Returning Patient
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  • First Name*
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  • Last Name*
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  • Phone Number*
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  • Email*
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  • What is the best time of day to reach you?*
    Morning
    Afternoon
    Evening
    Anytime
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  • Is it OK to leave a voicemail message if we cannot reach you?*
    No
    Yes
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  • Appointment Information
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  • Reason you are requesting an appointment:*
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  • First Preferred Appointment Date/Time
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  • Date*
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  • Time*
    Early Morning
    Morning
    Early Afternoon
    Late Afternoon
    No Preference
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  • Second Preferred Appointment Date/Time
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  • Date*
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  • Time*
    Early Morning
    Morning
    Early Afternoon
    Late Afternoon
    No Preference
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  • Additional Information
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  • Any notes or comments?*Do not include any confidential info!
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  • Validate & Submit
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  • Our office will contact you within one business day to confirm your appointment. We will do our best to accommodate your preferred date and times. Please call us at (757) 463-0000 or email mail@wtownsend.com if you need to change your request.
    Thank you for scheduling with us!
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  • Please verify you are a humanCopy the letters exactly as they appear into the space provided (there are no numbers)
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Dr. William Townsend, Optometrist

(757) 463-0000

www.drwtownsend.com

Monday and Wednesday | 8:00 AM – 6:00 PM
Tuesday | 12:00 PM – 6:00 PM
Thursday | 7:30 AM – 6:00 PM
Friday | 8:00 AM – 12:00 PM

4224 Holland Road
Suite 108
Virginia Beach, VA 23452

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