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Home » Contact Us » Appointment Request Form

Appointment Request Form

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

To request your next appointment, please complete the form below and let us know the most convenient time and date for you. Please don’t forget to include accurate contact details so we can follow up with you to finalize your request.

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
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  • This field is for validation purposes and should be left unchanged.
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Due to CDC Guidelines and the State of Alabama mandates, we are temporarily closed. We will continue to see ocular emergencies as needed. If you feel you have an eye emergency, please call 251-928-4076 and speak to an operator. We are answering non-urgent phone messages left at 251-928-4076 throughout the week and will be delivering glasses curbside by appointment. Thanks for your understanding during this difficult time. We are praying everyone stays well.

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