Appointment Request Form

Use this form to schedule an appointment or ask us a question regarding any procedure. Your contact information will be kept strictly confidential. Online appointment requests are handled weekdays during business hours.

If your eye problem issue needs immediate attention please call our offices at 612-338-4861.

Name*
Phone*
Email*
What method would you like us to use to contact you?
Phone Email
If phone, what time would you prefer to be called?
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