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Our Location

10071 N. Wadsworth Pkwy, Ste 200
Westminster, CO 80021

Home » Contact Us » Appointment Request Form

Appointment Request Form

If this is an emergency, do not contact us via email, please use our emergency contact information.

Complete the following form:

  • Please fill in the form below to setup an appointment.
  • Please provide the main reason for your appointment. Details are stored securely. -Annual Eye Exam (glasses and contacts) -Routing Medical Exam (diabetes, glaucoma, etc) -Medical Concern (pain, redness, infection, foreign object)
  • Our Hours: Mondays-closed, Tuesdays- 10am-7pm, Wednesdays- 8:30am-5:30pm, Thursdays- 8:30am-5:30pm, Fridays- 8:30am-5:30pm, Saturdays- 8am-1pm, Sundays-closed.
  • Please include the name of your Vision Insurance and have your member ID information ready. We will need to verify that your plan is accepted at our office. Examples: VSP (Vision Service Plan) EyeMed (plan specific) Spectera *Or you may have vision coverage under your medical insurance.
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  • This field is for validation purposes and should be left unchanged.