Please enter as much information as possible and we will call or email you to confirm your appointment.
If you are using insurance that requires forms or vouchers, all forms needed must be in your posession before you schedule an appointment.
If no forms are required we will verify your eligibility online.
To pick up eyeglasses or for simple repairs please do not fill out this form. Call the location and they will help you to find an appropriate time to enter one of our locations .
This form is HIPPA compliant and your confidential information is protected.