Existing Patients

*First time log in - Must have the password provided by Mohave Eye Center, if not, contact us by telephone.

New Patients

Please print, fill out, and bring the following forms to your appointment:
*Consent for Use and Personal Health Information
*Financial Responsibility
*Medical History Information
*Acknowledgement of Notice of Privacy Policies
- you can review our Notice of Privacy Practices HERE

To schedule an appointment, please fill out the following form and we will contact you with available appointment times. 

Name *
Please choose the location of your appointment.
Best Available Time(s) *
Check all that apply.
Please comment if you have a specific time preference.
Please indicate the day or range of days you would like to schedule your appointment.
Phone *
Enter the phone number you wish to be contacted by to finalize your appointment.
Contact Preference *
Please indicate your most preferred method of contact.