Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Vision Screening – Step 1 of 2 Parent/Guardian Age me Vision Screening with Dr. Kara Foster Please adhere to the following instrucitons: Sign up one person per slot. We will do our best to honor your time slot, however, we reserve the right to schedule you anytime during the open time slots. Time Slots are limited, so please be on time for your appt. If you need to cancel your appointment please email [email protected] so that we can reopen the slot. Thank you for your cooperation. Parent/Guardian Name *FirstLastEmail *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Fuquay (Friday, August 14)7:40 pm7:50 pm8:10 pm8:20 pmHolly Springs (Saturday, August 15)11:10 am11:50 am12:10 pm12:20 pm12:30 pm12:40 pmPatient's Name *Date of Birth (mm/dd/yyyy) *Patient's Age *All slots at my perferred location is filled. Please put me on the waitlist.FuquayHolly SpringsEitherNextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmit