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Please fill out the form below and one of our Patient Relations Representatives will be in touch with you soon. If you have an emergency, please call our office at 517-337-1668 immediately. Thank you.

Contact Information
Title
First Name*
Last Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Birth Date*
MM slash DD slash YYYY
Gender*
Additional Information
VIsion Insurance*
Medical Insurance*
How did you hear about us?*
Type of Appointment
- Routine
- Medical
- Free LASIK Screening
- Cosmetic Consultation
Doctors/Professional Staff
Ophthalmologists
Optometrists
Location*
- East Lansing - Coolidge Road
- Battle Creek
- Grand Ledge
- Howell
- Mt. Pleasant
- Okemos
Preferred Day*
Preferred Time*
- Morning
- Early Afternoon
- Late Afternoon
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About
Our Doctors
Services
Locations
Patient Resources
Referring Doctors

p. 1-800-292-1668

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