Appointment Request

Please submit the following information and our office will contact you to set up an appointment.

*Please do not include any personal health information on this form

Name

First Name

Last Name

Phone

(###)

###

####

Reason for Appointment

Preferred Office Location

Message

Please enter any other comments. If reason for appointment is Other, please specify reason here.

We only file with Medical Insurances and not Vision Plans

If you just want a refraction and want to use your Vision Insurance that covers routine examinations and glasses/contact lenses, then you should first schedule with an optometrist office. Affiliated optometrist offices with optical dispensaries that participate in Vision Plans are listed on this website.

Appointment Request

NRV Eye Center