Contact Us

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	Introduction

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	Introduction

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	Contact Directory

	Email Form

	Request an Appointment

	Comments Form

	Map & Directions


	Contact Directory

	Email Form

	Request an Appointment

	Comments Form

	Map & Directions

An appointment can be made by calling us at 952-469-EYES (3937) or by requesting one online. Should you call us to schedule an appointment, please have your address, phone number, and insurance information and card available. If you are calling with an emergency and must be seen that day, please have a description of your eye problem so that the staff may assist you in the best fashion based on your symptoms/needs.

Bold fields are required.

PATIENT INFORMATION

First Name

M.I.

Last Name

D.O.B.

Address 1

Address 2

City

State

ZIP

CONTACT PERSON INFORMATION

First Name

Last Name

Email Address

Daytime Phone

Preferred Method

Phone Email

APPOINTMENT INFORMATION

Doctor/Staff

Appointment Type

Preferred Days

Preferred:

Mon

Tue

Wed

Thu

Fri

Sat

Alternate:

Mon

Tue

Wed

Thu

Fri

Sat

Preferred Time(s)

Morning Afternoon Evening

Have you been to our clinic before?

Yes No

If not, how did you hear about us?

Do you wear contacts?

Yes No

If using insurance, list companies

Primary:
Secondary:

Any additional information or questions?

Home > Contact Us > Request an Appointment

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