First Name: * Last Name: * Address: * Date of Birth:     mm/dd/yyyy Phone Number: * E-mail:   New Patient       Existing Patient  Select a Doctor: Select a DoctorJames S. Allen, MD Scott R. McKee, MD Richard P. Stanek, MD Alan S. Weingarden, MD Dan A. Nichols, MD Honora E. Kennedy, MD Thomas J. Rice, MD James E. George, MD Phillip T. Sheridan, MD Aaron W. Tsai, MD Todd M. Watanabe, MD Scott A. Uttley, MD Susan J. Quick, MD Eric A. Steffen, MD Erik S. Bachmeier, OD Select a Location: Select a LocationDowntown Eagan Maplewood Midway Roseville West St. Paul Woodbury Type of Appointment:   Follow Up    Routine Eye Exam    New Problem (Describe problem)  Desired Day/Date:     mm/dd/yyyy Desired Time:   Morning       Afternoon  Disclaimer: If you register, make an appointment or submit any other information online, all your information is transmitted securely and is held in strictest confidence, adhering to HIPAA guidelines and protecting your privacy. * = Input is required