Online Appointment Request To request an appointment you can submit the following form, call us or click the button below to send us a text message. Text Us to Schedule an Appointment Appointment Request Form Please fill in the form below to setup an appointment.Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Patient Type* New patient Returning patient Please let us know if you are a new or existing patient.Name* First Last Parent/Guardian (if applicable) Date of Birth:* Phone*Email* Do you have vision insurance?* Yes No If yes, please provide who is the primary and the name of the insurance. How did you hear about us? CommentsPhoneThis field is for validation purposes and should be left unchanged.