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Request Appointment

You can use the form below to request and appointment and we will get back to you within 24 hours to confirm. Thank you!

Please fill out the form below to request an appointment with Focus Vision and Eye Care. After completing the below form, a vision care coordinator form our office will connect with you within 24 hours to set and confirm your appointment. In order to make your visit efficient for you, please complete your Patient Form, prior to your appointment.

Name*
First Last
Email*
Phone*
Address
Street Address City State Zip
Are you a new patient?*
- Yes
- No
Are you a contact lens wearer?
- Yes
- No
Preferred Appointment Time
- Morning
- Afternoon
Phone
This field is for validation purposes and should be left unchanged.