Appointment Request

Appointments

Office Hours:
Monday-Friday  7:30am - 4:30pm
Closed Saturday and Sunday

Getting Ready for Your Appointment
If you have not filled out your forms, please arrive 20 minutes prior to your appointment time and bring the following:

  • Current medication list
  • Photo ID
  • Insurance cards
  • Payment – If your insurance requires a co-payment, it will be collected at the time of service
Online Forms

Speed up you visit by completing the necessary forms below. For your convenience, download, complete and print the forms to bring to your appointment.

Patient Health Form - Download & Print
Registration Form - Download & Print
Financial Policy - Download & Print
HIPAA - Acknowledgement of Receipt and Notice of Privacy - Download & Print

 

Appointment Requests

Please note: We cannot process emergency requests through this form. If this is an eye emergency, please contact our office by calling 920-965-4700. If you are experiencing a medical emergency, please call 911.

To request an appointment, please complete the form below. Our office hours are Monday-Friday 7:30am-4:30pm. We will contact you within 24 hours to confirm your request. Be advised that your appointment is not finalized until we have confirmed with you.

This form cannot be used to schedule same-day appointments. For same-day appointments or to schedule your appointment by phone, please call 920-965-4700.

Important: Please be aware this is a non-secure form of communication. Please do not include any personal medical information. If you have a medical question you would like answered by email, please log into your EyeClinic.net account.