Appointment Request Form

Please fill in the form below to setup an appointment.
Location
- Oxmoor
- Springhurst
- LaGrange
- Carrollton
Reason for Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Phone*
Email*
Date of Birth
MM
DD
YYYY
Best Time to be Reached for Confirmation*

: HH

MM
Comments
You affirm that you are either more than 18 years of age, or an emancipated minor, and are fully able and competent to enter to submit this online form.*
Phone
This field is for validation purposes and should be left unchanged.

Starting the week of March 30th, we will be open Monday to Friday, 10 AM to 2 PM.

We will have a team member available to take your calls to place eyewear and contact lens orders, handle shipping requests, and answer any questions about eye emergencies and eye health. All orders taken over the phone will be shipped to your address on file with Free Shipping.

If you have an Eye Emergency, please call the following:

Carrollton – 502-732-5006

LaGrange – 502-225-0301

Oxmoor – 502-423-8500

Springhurst – 502-429-3630

Thank you for your patience and understanding!