Request an Appointment

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Thank you for choosing Retina Associates of Utah. If this is not a retina-related emergency, please fill out the form below, and someone from our team will get back to you within 1-2 business days.

asterisk (*) denotes mandatory fields

First Name *

Last Name *

Email *

Phone *

Alternate Phone

Insurance

Referring Doctor

Preferred Day of Week

Preferred Time of Day for Appointment

Morning

Afternoon

Current Patient?

Yes

No

Preferred Physician (if any)

NoneDr. WinwardDr. SwartzDr. KwunDr. BrintonDr. Howard

Appointment Reason

Submit FormPlease leave this field blank.