Request an Appointment

At OptiView Family Eyecare PLLC, we provide the highest quality service to all our patients. Use the form below to request your appointment. Please indicate your preferred date and time. Please note that we will reach out to you first to confirm your appointment or to provide you with an alternative date. You may also call us to request an appointment. Thank you!​​​​​​​

Patient Type *

New patients: Please arrive 15 minutes early to complete paperwork

Date of Birth (Optional)


Helps us provide age-appropriate care

Appointment Details

Service Type *

Preferred Date *

Preferred Time Slot *

Mon–Wed: 8:30 AM – 5:00 PM | Thu: 9:30 AM – 6:00 PM | Fri: 8:30 AM – 4:00 PM

Reason for Visit (Optional)

Insurance Information

Do you have vision insurance?

Additional Information

Special Accommodations (Optional)

Preferred Contact Method

Emergency Contact (Optional but Recommended)

By submitting this form, you acknowledge that you have read and agree to our privacy policy regarding the collection, use, and storage of your personal information.

Helpful Articles
Eye Care Services

Services

Learn More
Contact Us

Keep In Touch

Contact Us