559-784-4063
*We will make every attempt to make an appointment as close to your request as possible.
Appointment confirmation will be sent to your email.  There is no guarantee to appointment time prior to
confirmation. Thank you for your understanding.

** Please make requests at least 2 weeks prior to desired appointment time and date. **
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email:

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Appointment Request
Date:

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(if taking any medications
please make sure to list the
names.)
Thank You.
First, Middle Initial, Last
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No
Appointment Request Form
Confirmed Appointments:

If you have an upcoming appointment and have your pass-code please visit:
https://www.crystalpm.com/index.jsp?crystalpmid=1643
Eye & Vision
Center
Robert D. Gillett, O.D.
559-784-4063
418 W.Putnam Ave
Porterville, CA