Request Vision Exam

Name (required)

Date of Birth
New Patients Only
Phone

Email (required)

I would like to schedule a vision exam with:

Dr. Keith Letts (Monday only)Dr. Candace DeCock (No Mondays)Dr. Dustin McGillNo Preference

Information regarding your vision examination:

- Please arrive a few minutes before your appointment time
- If you wear contact lenses, please wear them to your appointment & bring your glasses
- Bring a list of any medications you are taking
- Bring all 3rd party insurance numbers

Please indicate any specific questions or concerns briefly below:

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Thank you for your business!