Appointment Form for OrthoK and Gentle Vision Shaping System Consultation Appointment Form for OrthoK and Gentle Vision Shaping System Consultation Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred date and time*Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.Patient type*New PatientReturning PatientName* First Last Phone*Email* Does the patient currently wear glasses and/or contact lenses? Yes No Best Time to be Reached for Confirmation* : HH MM AM PM Comments