Request an Appointment

Please use the form below to submit your appointment request, and our office will get back to you to schedule your appointment.

First Name

Last Name

E-mail Address

Phone Number

What is your patient status at Doctors Eyecare?

I am a new patientI am an existing patientI'm not sure - please check your files

What type of appointment are you requesting? Check all that apply.

Eye Exam ($130.00)Child Eye Exam (18 Years and Under)Senior Eye Exam (65 Years and Older)Care 1 ExamContact Lens Exam (price varies)Partial Eye Exam ($65.00)Emergency Eye ExamFollow-Up

Who is your preferred optometrist?

Dr. Mike JoljartDr. Kelsey FordNo preference

Please indicate the preferred date and time for your appointment.

Please note we do our best to accommodate requests, but cannot guarantee availability. If your preferred date and time is not available, we will contact you with the best available alternative(s).

Month

Day

Time

How would you like Doctors Eyecare to contact you regarding your appointment request?

E-mailPhoneNo preference

Prefer to book your appointment by phone? Feel free to give us a call!

Request an Appointment

Request an Appointment

780.467.2145

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