The first step towards better vision is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

For urgent problems or emergencies, please do NOT use this form. Call our office

directly at 317-770-8555. If outside of normal business hours, use the 'Emergency'

option and leave a message with your name, the nature of the problem, and a

contact number.


*Items in bold are required.
Name:  
Address:
City:
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Email:
Phone:  
Are you a current patient?
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Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):
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Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.