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?
    *

    San Bernardino 1585 South D StreetCanyon Lake 31570 Railroad Canyon RdPalm Springs 717 S. Eugene RdHemet 3750 East Florida AveApple Valley 22749 Highway 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