Eyewear Store Appointment Request Form
Please complete this Eyewear Store Appointment Request Form to book your visit. Our team will confirm your appointment as soon as possible.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Appointment Date and Time
*
Type of Appointment
*
Eye Exam
New Glasses Consultation
Contact Lens Fitting
Frame Adjustment
Other
Are you a new or returning customer?
*
New Customer
Returning Customer
Preferred Store Location
*
Please Select
Downtown
Uptown
Suburban
No Preference
Eyewear Interests
Prescription Glasses
Sunglasses
Contact Lenses
Children's Eyewear
Designer Brands
Other
Do you have a current prescription?
Yes
No
Not Sure
Additional Notes or Requests
Request Appointment
Should be Empty: