Request Appointment

For urgent issues or emergencies, ReFocus strongly recommends calling a location nearest you. For after-hours eye emergencies, please visit your local ER or urgent care center or dial 9-1-1.

To request an appointment, please fill out the following form and make sure to choose a location from the dropdown. If you do not see the clinic location you’re looking for, you can call one of our practices directly from here.

Are you a new or returning patient? *

First Name *

Last Name *

Mobile Phone *

Date of Birth

Practice Location *

Appointment Type *

Were you referred to us? *

No
Yes

Doctor First Name *

Doctor Last Name *

Notes

Please do not share private or personal medical information.

ReFocus Eye Health does not administer COVID-19 vaccines. Please contact your local health department or primary care physician for information regarding obtaining a COVID-19 vaccination.

Please use this form for non-urgent matters only. We try to respond to inquiries within 24 hours and responses are only made during normal business hours. Thank you!

If you need to cancel an appointment, please call us Monday-Friday between 8:30am-4:00pm at least 24 hours before your scheduled appointment or you may incur a fee - read the full cancellation policy here.