Schedule Appointment Request

Name (required)

Phone (required)

Your Email (required)

Are you a new patient or existing?


What is the name of your vision insurance? (type 'none' if you do not have it)


Preferred day of the week?


Preferred time?


Service Requested (required)

Comments (please leave additional questions or comments related to your appointment.

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Please note that the date and time you requested may not be available. We will contact you during normal business hours to confirm your actual appointment details. Please call 817-514-0100 and speak to our staff for same day appointments. Thank you.