Ready to Schedule Your Appointment?
Simply fill out the form below, and one of our team members will contact you as soon as possible to finalize the details and get your appointment scheduled!
Patient's Name
First Name
Last Name
If you are a new patient, or have any updates to insurance etc... please detail those below (new patients we will need you date of birth, full name, address, phone number and email)
Parent/Guardian's Name (if applicable)
First Name
Last Name
What type of appointment did you want to schedule?
Eye exam-existing patient
Eye exam-new patient (welcome!)
Other
Is there a specific doctor, date, or time that you would like us to look for?
Which location would you like to schedule your appointment at?
Westerville office: 185 South State Street
The Solution Center (pediatric office): 937 Polaris Woods Blvd
Johnstown Office: 703 W Coshocton St
Lewis Center office (in the Mount Carmel Fitness Center): 7100 Graphics Way
How would you like us to contact you to schedule this appointment?
Text
Email
Phone call
Email
example@example.com
Phone Number
If you would selected "Text Me," please provide a cell phone number that can receive text messages.
Submit
Should be Empty: