Ready to get started?Complete the form below Your Name * First Name Last Name Cell Phone * (###) ### #### Email * How did you hear about us? School / Teacher Educational Psychologist Eye Doctor Pediatrician Coach Friend Self / Web Search Main Concern Reading / Learning Vision Symptoms Eye Turn / Lazy Eye Concussion Sports Performance Other Patient's Name * First Name Last Name Date of birth * MM DD YYYY School Grade Most recent eye exam MM DD YYYY Eye exam provider Vision Symptom Checklist Score Are there any special needs Dr. Toler needs to be aware of? No Yes Activites / Sports participation: What are your goals and expectations for pursuing a Binocular Vision Evaluation and possible treatment? * Thank you for your inquiry.Here is a link to Dr. Toler’s Vision & Learning webinarClick Here
