Virtual Consultation Request

Request a Virtual Appointment

Virtual Care appointments are just like regular visits at the doctor, except that the entire process is completed online, from wherever you want. Please ensure you have a suitable, quiet environment for confidential conversation. You will require an internet connected device with a camera and microphone, allowing you to meet from the comfort of your home, from the office or wherever you may be.

HOW IT WORKS

It's as easy as
One, Two, Three...

Request Appointment

Complete the following form to request an online appointment using your computer or mobile device.

Await Confirmation

Our office will review your request, confirm, and email you further instructions.

Virtual Assessment

Prior to your scheduled time, simply click the link from the instructions you received to meet with Dr. Rocha.

Virtual Appointment Request Form

First Name (required)

Last Name (required)

Are you an existing patient? (required)

Yes

Do you have a device with camera and microphone? (required)

Yes

Email address (required)

Cell Phone (required)

Reason for Virtual Eye Consultation (required)

Are you human? (required)

This field should be left blank

Please wait...