Request an Appointment Appointment Request Form Basic form for clients to request an appointment with the practice. Please keep in mind we might not be able to accommodate same-day appointment requests, but we will fit you into our schedule as soon as we have an opening. Please fill in the form below to set up an appointment.Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred Date & Times*Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.Patient Type*New patientReturning patientPlease let us know if you are a new or existing patient.Name* First Last Phone*Email Preferred Method of Contact*PhoneTextEmailInterested in Contact Lenses?*YesNoCommentsCommentsThis field is for validation purposes and should be left unchanged.