Appointment Request

Request an Appointment with Image Prosthetics

To schedule an appointment, please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

Items in bold are required.

Name:
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
YesNo

Best time(s) to call?
MorningNoonAfternoonEvening


Which office location(s) would you prefer for your appointment?
*

GRAND TERRACE 22365 BARTON RDCanyon Lake 31570 Railroad Canyon RdPalm Springs 717 S. Eugene RdAPPLE VALLEY 22749 HWY 18 SUITE A-3APPLEVALLEY 22749 HWY 18 SUITE A-3

Preferred day(s) of the week for an appointment?

Any DayMondayTuesdayWednesdayThursdaySaturdaySunday

Preferred time(s) for an appointment?

Any TimeMorningNoonAfternoonEvening

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Our Services

Ocular and Facial Prosthetics in Inland Empire, CA - Image Prosthetics

  • Custom Fabrication And Fitting Of Prosthetics
  • Custom Fit Auricular Prosthetics
  • Custom Fit Hemi-facial Prosthetics
  • Custom Fit Nasal Septal Prosthetics
  • Custom Fit Nose Prosthetics
  • Custom Fit Orbital Prosthetics
  • Custom Fit Temporary Ocular Prosthetic Eyes
  • Custom Fit Trial Shell Prosthetics

Call : (909) 824-2980

Monday - Thursday 8:30 - 4:30 pm
Friday & Saturday by Appointment Only