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Patient Intake Form

You can fill out the patient intake form online but submitting the below form. We're excited to learn more about you to help discover your ideal eyecare plan.

Patient Intake Form

If you would like to download a PDF version to bring into our office, click here.

In need of 24/7 emergency care services?
In need of emergency eye care? Click the button below to call our 24/7 emergency line.

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24/7 Emergency Care

In need of emergency care? Please call us at (563) 263-2020. Skip the waiting room, we will have one of our Doctors meet you at our clinic to take care of your emergency needs.

If you are calling outside of work hours, one of our Doctors will be paged and continue to meet you at our clinic. 

Call Now: (563) 263-2020

24/7 Emergency Care

In need of emergency care? Please call us at (563) 263-2020. Skip the waiting room, we will have one of our Doctors meet you at our clinic to take care of your emergency needs.

If you are calling outside of work hours, one of our Doctors will be paged and continue to meet you at our clinic. 

Call Now: (563) 263-2020

24/7 Emergency Care

In need of emergency care? Please call us at (563) 263-2020. Skip the waiting room, we will have one of our Doctors meet you at our clinic to take care of your emergency needs.

If you are calling outside of work hours, one of our Doctors will be paged and continue to meet you at our clinic. 

Call Now: (563) 263-2020