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Online Patient Registration Form

lock icon Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office. This form contains confidential information and is delivered to your doctor through a secure Internet connection.

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The Eyeglass Shoppe in now part of

the MyEyeDr team!

Please do not submit appointment requests or contact forms through this website. Instead please email latrobe@myeyedr.com or somerset@myeyedr.com with any questions, visit MyEyeDr.com to schedule an appointment online or call the offices during normal business hours.

Thank you!