Appointment Request Form

Name: Fort Meade Family Eye Care
Address: 2799 Rose Street Suite 3, AAFES Exchange, Fort Meade, MD, 20755, US
Telephone: 410-305-4142 Ask for an appointment with Dr. Cross
Price range: $000 - $300

Please note doctor’s schedule:

The doctor examines patients on Wednesdays, Thursdays, and Fridays.
The office is open 6 days a week but Dr. Cross gives patient care on Wednesdays, Thursdays, and Fridays only.

Ask for an eye exam with Dr. Cross

Please fill in the form below to setup an appointment.
Reason for Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date & Times (Wednesdays/Fridays only!)*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page. The office is open 6 days a week but Dr. Cross gives patient care on Wednesdays - Fridays only.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Phone*
Email*
Best Time to be Reached for Confirmation*

: Hours

Minutes
Comments
If you have TRICARE what plan are you on?
TRICARE
PRIME EAST
PRIME EAST RETIRED
SELECT ACTIVE DUTY SPONSOR
RESERVE ACTIVE DUTY SPONSOR
DO NOT HAVE (go to next survey)
I AM ACTIVE DUTY (you are out of pocket)
We DO NOT take TRICARE FOR LIFE, TRICARE WEST, TRICARE OVERSEAS, TRICARE families off of ACTIVE DUTY ORDERS, JOHNS HOPKINS USFH, MEDICARE, MEDICAID, or VSP. If we don't take your vision plan we will see you out of pocket.
Phone
This field is for validation purposes and should be left unchanged.

	TRICARE
PRIME EAST
PRIME EAST RETIRED
SELECT ACTIVE DUTY SPONSOR
RESERVE ACTIVE DUTY SPONSOR
DO NOT HAVE (go to next survey)
I AM ACTIVE DUTY (you are out of pocket)

Ask for an eye exam with Dr. Cross

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Fort Meade Family Eye Care