(417) 886-EYES (3937) • (800) 995-3180 size-upsize-normalsize-down


(417) 886-EYES (3937) • (800) 995-3180


Appointments & Patient Registration Forms

If you would like to schedule an appointment, please complete the form below and someone from our office will contact you shortly to confirm your appointment details. Please be aware that you are submitting a request only.

Until you have been contacted by a representative from our office, you do not have an actual appointment.

Please do not attempt to request a "same day appointment" via this web site, however same day appointments may be available. Please call our office for further details.

Note: To serve you better, all fields are required for the following form unless marked as optional.

Do you already have an appointment?
SAVE TIME!

Click on the link below, print the form, fill it out and bring it with you to the office.

Patient Registration Form

Patient Information

Format: mm/dd/yy
To help prevent Spam, type the characters you see in the image above.

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