Your Name (required)
Your Email (required)
Your Telephone (required for confirmation)
Desired appointment date (required)
Desired appointment window (required)
10:00am10:30am11:00am11:30am12:00pm12:30pm1:00pm1:30pm2:00pm2:30pm3:00pm3:30pm4:00pm (Mon-Fri)4:30pm (Mon-Fri)5:00pm (Mon-Thurs)
Note we are closed by 5pm on Friday and closed on Sunday
Reason for your appointment (required)
The following details are optional but will help speed up the appointment process.
Your Date of Birth (required)
123456789101112 / 12345678910111213141516171819202122232425262728293031 / 2006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901
Your Insurance Provider (required)
Please note we have implemented a cancellation policy, a no show appointment may result in a $40 charge.
Please submit your patient information in advance of your appointment to ensure prompt check in on arrival. Please select your method for submitting your patient information below:
Submit Online Patient Form
The online form submits your information directly via email to us, no information is saved on our website.
Download Patient Form
A downloaded form will need to be filled out and sent back to us via email or fax.
IC Optique ©2020
Find what to wear with quality care.