Schedule an Optical Appointment with American Vision

Appointments

	Want to schedule an appointment? Don't have the time to call? This quick Email form will get the process started for you. Just fill out the form and submit it. We'll get back to you with a quick response to confirm your appointment. Thanks for coming in for a visit.
	Note: Required fields are in red
	First Name
	Middle initial
	Last name
	Date of birth
	Email
	Daytime phone

	Please choose 2 appointment dates, in order of preference, that you prefer.
	Choice 1: Choice 2:

	What time of day would you prefer? (check one)
	Morning Afternoon Either
	Have you ever been a patient at American Vision at the Court before? yes no
	If so, approximately when:

	Reason for your visit and/or additional information that you wish to provide us:

	How would you like us to confirm your appointment?
	phone - preferred and fastest method of confirmation email

Before submitting this appointment request with the button below, please re-read your entries to ensure that your information is accurate and read the following privacy statement. The information you supply via this appointment form is considered strictly confidential and will never willingly be shared with anyone without your explicit permission. If you deem the information we ask for to be sensitive, the only way to ensure its absolute security is to discuss it with the doctor face-to-face. We encourage you to do so by requesting an appointment by phone.