Schedule an Exam

Fill in the info below to request an appointment. We will text you back shortly! Thank you!

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Patients Name *

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Cell Phone number *

Email *

Patients Date of Birth *

Please choose the type of Eye Exam *

Eyeglasses Exam only Contact Lens Evaluation & Eyeglasses Exam

Will you be using any Vision Plan Insurance? *

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If you will use insurance, what vision plan and ID number do you have? (if you are not the primary, please list the primary insureds name, DOB and last 4 of SSN) *

What date and time would work best for you? (we are Tue-Sat) *

Please let us know anything else that may be helpful to us in making your appointment *

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Schedule an Eye Exam with Dr Jorgensen today!

Fill in the info below to request an appointment. We will text you back shortly! Thank you!

We Would Love to Have You Visit Soon!

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