Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!Name Phone* Email* Preferred Day(s) of the Week* Monday Tuesday Wednesday Friday Saturday We are currently only taking new patients by referral. Please let us know the name of the doctor, patient, friend, etc that referred you to our office: Which doctor were you referred to? Richard "Richy" H. Miyasaka, O.D. James "Jimmy" K. Miyasaka, O.D. Nature of VisitCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.