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Appointment Request Form

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
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  • This field is for validation purposes and should be left unchanged.
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COVID-19 Announcement

We will be open 9:30-3:00 Monday- Friday. This is only by appointment. We are asking patients to make an appointment with us if they need their glasses adjusted/fixed or need to pick up glasses or contacts. Our door will be locked otherwise. If you have an eye emergency please call the office 712-754-4621. If this is an after hour emergency please call Dr. Jill at 712-728-3440.