Request an appointment 1 Contact Details 2 Preferred Appointment 3 Submit Appointment Contact DetailsTitle**Title*Mr.Mrs.MissFirst name** Last name** Telephone*Email* NotesPreferred AppointmentDate* MM slash DD slash YYYY Select Time**Select Time*Early MorningLate MorningEarly AfternoonLate AfternoonDate* MM slash DD slash YYYY Select Time**Select Time*Early MorningLate MorningEarly AfternoonLate AfternoonOffice LocationOffice Location*Select Branch*Fort Wayne NorthFort Wayne SouthwestWarsawAppointment detailsAppointments* Comprehensive Eye Exam Contact Lens Consultation Δ Request your appointment and a member of the team will call you back Request an Appointment Please do not submit any Protected Health Information (PHI). If you have an emergency please call 911