This form is not monitored around the clock. If this is a medical emergency, or you have sudden vision loss, eye pain or an eye injury, go to your nearest hospital or call 911.

Appointment request

Request an eye exam

Answer three quick questions and we'll reach out to confirm a time that works for you.

1. Insurance
2. Your details
3. How to reach you

What insurance do you have?

We'll tell you right away whether we're in network.

Insurance plan

We'll confirm your coverage when we contact you.

Who should we contact?

Only used to schedule your exam.

Full name

Phone number

Email address

How would you like us to reach you?

We'll follow up during business hours to confirm a time.

Preferred contact method

Phone call Text message Email

Best time to reach you

Anything else we should know?