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Appointment Request Form

If this is an emergency, do not contact us via email, please use our emergency contact information.

To request your next appointment, please complete the form below and let us know the most convenient time and date for you.  Please don't forget to include accurate contact details so we can follow up with you to finalize your request.

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
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  • This field is for validation purposes and should be left unchanged.
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Covid-19 (Coronavirus)

As your eye health care provider, you can trust that we always take health and patient care seriously. The wellness of our associates, our patients, and our community is of the utmost importance to us.

Our practices are temporarily closed to routine patient care from March 19 through April 3rd.

ORDER CONTACT LENSES (this should link to https://www.myeyedr.com/contact-lens-ordering)

through our partner, MYEYEDR.