Appointment Request Form

Please feel free to fill in the following form to request your appointment. The team at Wilson Eye Center looks forward to your visit!

Please fill in the form below to setup an appointment.
Reason for Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Date Of Birth*
MM
DD
YYYY
Phone*
Email*
Best Time to be Reached for Confirmation*

: HH

MM
Comments
Email
This field is for validation purposes and should be left unchanged.

We are now seeing patients by appointment only for ALL eye care needs, Monday-Friday, 8:30 a.m. – 5:00 p.m.

Please call the office today to schedule your next eye exam.

Please bring a mask or face covering to wear during your scheduled appointment. We also ask that all patients arrive alone unless accompanied by ONE parent or caregiver.

Learn more about our COVID-19 office policies and procedures.

It is our primary goal to keep everyone safe, so please be patient with us while we take the appropriate precautions to minimize health and welfare risks to our patients and team members.

WE APPRECIATE YOU! — The WEC Family

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Appointment Request Form

Wilson Eye Center