Contact Us

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=82 BGCOLOR="#003333" TEXT="#F7F7FF"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>Brentwood Eye Clinic</B></FONT><B>     |   </B><B>  </B><A HREF="index.htm" TARGET="_top" TITLE="Brentwood Eye Clinic"><U><B>home</B></U></A></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="Brentwood Eye Clinic"><U>Brentwood Eye Clinic</U></A>   |   <A HREF="about.htm" TARGET="_top" TITLE="About Us"><U>About Us</U></A>   |   <A HREF="news.htm" TARGET="_top" TITLE="News and Events"><U>News and Events</U></A>   |   <A HREF="location.htm" TARGET="_top" TITLE="Location"><U>Location</U></A>   |   <B>Contact Us</B>   |   <A HREF="products.htm" TARGET="_top" TITLE="Our Products and Services"><U>Our Products and Services</U></A>   |   <A HREF="privacy_practices.htm" TARGET="_top" TITLE="Privacy Practices"><U>Privacy Practices</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#003333" TEXT="#F7F7FF"> <div> Office Hours:</div> <div> Mondays - Thursdays</div> <div> 8:30 a.m. to 6 p.m.</div> <div> Fridays</div> <div> 8:30 a.m. to 2 p.m.</div> </td> <td valign="top" height=398 BGCOLOR="#006633" TEXT="#F7F7FF"> <div> <I>Contact Us</I></div> <div> We look forward to caring for you!</div> <div> <A HREF="mailto:sherreesaleh@bellsouth.net" TARGET="_top" TITLE="mailto:sherreesaleh@bellsouth.net"><U>Contact us via e-mail</U></A>.</div> <bR> <div> or call (615) 373-4747</div> <bR> <div> Brentwood Eye Clinic</div> <div> 5554 Franklin Road</div> <div> P.O. Box 35</div> <div> Brentwood, TN 37024-0035</div> <bR> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Company,Address1,Address2,City,State,Zip,Phone,MailingList,Comments"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request for information."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A request form was submitted"><input type="hidden" name="tlx_EmailTo" value="info@brentwoodeyeclinic.com"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Company:<br> <input type="text" name="Company" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 1:<br> <input type="text" name="Address1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 2:<br> <input type="text" name="Address2" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Zip:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td> <input type="checkbox" name="MailingList" value="yes"> Add me to your mailing list</td> </tr> <tr> <td align="left">Comments:<br> <textarea name="Comments" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> </td> </tr></table></body>