Envision Eye Care – Dr. Arnette

Name*
Phone Number*
Email Address*
How satisfied were you with your visit? 1 being extremely unsatisfied and 10 being extremely satisfied*
1 2 3 4 5 6 7 8 9 10
How likely would you be to recommend Dr. Arnette to a friend?*
- Very likely
- Somewhat likely
- Somewhat unlikely
- Very unlikely
Please explain your response here*
After your visit, did you have a good understanding of your condition or assessment?*

Call Marion Office
276-262-6464
Call Cedar Bluff Office
276-218-3210
Call Bristol Office
423-418-5513
Call Abingdon Office
276-628-1143
Call Abingdon Office
423-418-8593

Bristol: (423) 418-8605

Marion: (276) 521-5172

Cedar Bluff: (276) 240-3911

Abingdon: (276) 477-2199

Gray: (423) 418-8593

SEFT-TEST FORM

Dry eye disease is a common and uncomfortable condition, yet it often goes undiagnosed. If you’re experiencing dry eye symptoms, complete this self-test form to see if you meet the requirements for diagnosis.

Your Name(Required)

First Last

Have you experienced dryness, grittiness or scratchiness in your eyes in the last 30 days?

Yes

Do your eyes often feel sore or irritated?

Yes

Have you experienced your eyes burning or watering in the last 30 days?

Yes

Do your eyes feel tired or fatigued?

Yes

Enter your email for more information about dry eye and how the experts at Envision Eye Care can help you feel (and see) better!(Required)

Patient Type?*
- New patient
- Existing Patient
Choose Location**
Reason for Appointment
Preferred Date
Preferred Time
First Name*
Last Name*
Phone*
Email*
Additional Information

Book an Appointment
Choose a Location
Reason for Appointment
Preferred Date
MM slash DD slash YYYY
Preferred Time
Patient Type
- New Patient
- Returning Patient
Name
First Name Last Name
Phone
Email
Comments

Request An Appointment

Full Name*
Phone*
Email*
Date of Birth
MM slash DD slash YYYY

CALL US NOW

Marion: 276-262-6464

Cedar bluff: 276-218-3210

Bristol: 423-418-5513

Abingdon: 276-262-6383

Due to CDC guidelines, we will only be seeing emergency eye patients at this time. Please call our office if you have an eye emergency. Thank you for understanding

Call Marion Office 276-521-4446

Call Cedar Bluff Office 276-991-3171

Call Bristol Office 423-546-4536