IRREGULAR CORNEA & SCLERAL LENS CLINIC

Keratoconus - Myopia Control - High Prescriptions - Scleral Lenses - Medically Necessary Contact Lenses-Rigid Gas Permeable Contact Lenses - Ortho-Keratology - Post-Refractive Surgery Correction - Custom Multifocal Correction - Tori-Vision (TM) Custom Cornea Shaping - Post-Transplant Custom Correction

CONSULTATION INSTRUCTIONSAtlanta Cornea Care Center

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Let's Connect!

Consultation Connection Form

The contact form below is for new consultation patients.

First name*

Please enter the patient's first name.

Last name*

Please enter the patient's last name.

Email*

Please enter the patient's email.

Phone*

Please enter the patient's phone number.

Birthday*

Month

Day

Year

Patient's date of birth.

Note: Patient records must be encrypted if uploaded here. Please do not send HIPPA information unencrypted. You may send a passcode to info@atlantacorneacare.com

I would like a consultation for*

Poor vision after refractive or cornea transplant surgery.

A cornea condition like keratoconus or hereditary disease.

Poor comfort in current corrective lenses.

Poor vision in current corrective lenses.

Cornea Shaping/myopia control/Ortho-K/VST

Other

I understand this form isn't for emergency communications. I understand that the consultation fees are either $210 or $225 and will be due at appointment scheduling. I am authorizing The Atlanta Cornea Care Center - Dr. Kenyatta Brantley, Optometrist (P.C.) to receive and review my vision records in preparation for my consultation appointment.

Signature*

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You may sign this to begin the records release process.

Address

37 Calumet Pkwy, Bldg. G.,

Ste. 101

Newnan, GA 30263

Phone

(229) 800- 4712

info@atlantacorneacare.com

A picture of the front of the Atlanta Cornea Care Center building G.

Atlanta Cornea Care Center
Dr. Kenyatta Brantley,
Optometrist (P.C.)

37 Calumet Pkwy, Bldg G
Suite 101
Newnan, GA 30263
229-800-4712

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Consultation Connection Form

Atlanta Cornea Care Center Dr. Kenyatta Brantley, Optometrist (P.C.)

37 Calumet Pkwy, Bldg G Suite 101 Newnan, GA 30263 229-800-4712

Atlanta Cornea Care Center
Dr. Kenyatta Brantley,
Optometrist (P.C.)

37 Calumet Pkwy, Bldg G
Suite 101
Newnan, GA 30263
229-800-4712