My Future College Athlete Contacts Appointment Form My Future College Athlete Contacts Form for My Future College Athlete to request an appointment with the practice. Please fill in the form below to setup an appointment.Name* First Last Email* Phone*Athletes AgePreferred Appointment Date* MM slash DD slash YYYY Preferred Appointment Time* : Hours Minutes AM PM AM/PM Sport PlayedSchool/College Name Current Visual Concerns or Special Notes Hyperopia Myopia Astigmatism Amblyopia Strabismus Headaches Blurred Vision Double Vision Eye "hurt" or "tired" Itchy Eyes Eye Drainage Eye Redness Do you wear glasses or contact lenses?Do you wear glasses or contact lenses during sport/competitionWhat areas you would like to improve? Visual Tracking Visual Reaction Time Eye-hand Coordination Peripheral Awareness Depth Perception Visual Endurance Visual Concentration Visual Relaxation Visual Consistency Improve Figure-ground Awareness Decrease Visual Distractibility Block Out Distractions Previous Vision TrainingSelectYes, currently in a vision training programYes, completed a vision training programNo previous vision trainingMedical ConditionsHow Did You Hear About Us? Referral My Future College Athlete Social Media Other Consent to Communication* I agree to receive communications related to the appointment.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ