Appointment Request Form

UNDER NEW OWNERSHIP

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Call 952 226 2020 to schedule an eye exam Located on Highway 42 in O'Connell Square
Visit our optometrist for your eye exam

Home \ Contact Us \ Appointment Request Form

If this is an emergency, do not contact us via email, please use our emergency contact information.

Complete the following form:


Location Required
Doctor Required
Reason for Appointment	Appointment requests are sent to your practitioner using regular email so please do not enter confidential information.
Preferred Dates & Times Required	Check our office hours
First Name Required
Last Name Required
Telephone Required
Email
Best Time to be Reached for Confirmation Required
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