AppointmentsPlease use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you! Upon receipt of your email, our staff will call to schedule the appointment. Please have your vision insurance information readily available.NamePhone*This appointment request is for a:*New PatientExisting PatientEmail* Vision Insurance Provider (VSP, Eyemed, Etc.)*Please note that we do not accept Spectera, Superior Vision, or Davis vision plans. Additionally, we are not in network with any IN Medicaid, Caresource, or HIP plans.Preferred Doctor:*SmithWaglerRiinaTillNo PreferencePreferred Date* Preferred TimeMorningAfternoonEveningUntitled*complete/yearly exammedical visit (eye problem)PhoneThis field is for validation purposes and should be left unchanged.