Eye Exam Registration Save time at your first appointment General InformationSelect Office*Select a LocationBel AirBelvedere SquareEldersburgLuthervilleOverleaParkvillePerry HallPikesvilleReisterstownTowsonWestminsterSelect Doctor*Select a DoctorRichard K. LevinHoward H. LevinIsmail Shalaby, M.D., P.h.D.Michael SandlerChristina AntonopoulosTania MarcicGregory M. BarbushJenna SembratJillian ChapmanSamantha R. HouseJennifer L. StoneRon SurdinBenjamin RubinCarl WaxmanMindabeth LevinDr. Judy HuSendto Email Patient Status*Patient StatusNew PatientCurrent PatientNot a PatientFirst Name*Last Name*Birth Date* Gender*Select GenderMaleFemaleMarital Status*Select StatusSingleMarriedDivorcedWidowedAddress* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Email* Tel*Cell*SSN*Primary Care Physician:*Referring Physician:*Emergency Contact:*Phone*Whom may we thank for referring you to us?*Insurance InformationInsurance Company*Insurance ID #*