Request Appointment

We now offer an appointment scheduling service online for your convenience. You will be able to request mornings, afternoons, and the day of the week preferred.  Just submit the form below.

Please note:

  • If there are certain times of the day that would be best for you, please indicate that in the Message box.
  • If you have broken glasses, lost contact lenses, or have a medical eye emergency, you should call us directly so we can make the most immediate opening available to you.
  • Our office hours are listed on the Locate Us page of our Web site. You may e-mail us 7 days a week, 24 hours a day, and we will respond as soon as possible when the office is open.
  • Fill out the appropriate information below for an Eye examination or Contact Lens fitting appointment.
  • Appointments are not needed to fill eyeglass prescriptions. Simply come in during office hours.

Appointment Request Form

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you except when we have your permission.

    Personal Information:

    First Name: Middle: Last Name: (required)
    Street:
    City: State: Zip:
    Birthdate: MM/DD/YYYY (required)

    Contact Information:

    Home Phone:
    Work Phone:
    Cell Phone:
    Email Address: (required)
    Contact Preference(s): Home PhoneWork PhoneCell PhoneEmail

    Appointment Information:

    Are you a New Patient? YesNo
    Appt. Time Preference: MorningsAfternoonsNone
    I wear contacts or want to be fit for contact lenses: YesNo
    Which Insurance, if any, will you be using?:

    Message or Reason for Appointment: