Dr. David W. Gordon, Optometrist

Please complete the following form for more information and/or to receive a free pre-exam consultation.

First Name: 
Last Name: 
Title: 
Company: 
Street Address: 
City:  State: Zip:
Business Phone#: 
Home Phone#: 
Fax Number: 
Email Address: 
Best Time to Contact: 
Best Way to Contact:  -Phone -Fax   -E-Mail 
Would You Like a FREE Consultation?    -Yes -No

To receive the consultation, please enter your current eyeglass or contact lens prescription into the comments box below:

Eyeglasses:
  • O.D. (right eye) {ex. -4.00 -0.25 x 145)
  • O.S. (left eye) {same as OD}
Contacts:
  • O.D. {ex. 8.8/14.0/-1.50}
  • O.S. {same as OD}
  • Soft, Hard, Brand
Comments: 


email

DR. DAVID W. GORDON, OPTOMETRIST
(818) 842-2111
info@drgordon.com
©2002, All Rights Reserved.