Appointment Request

Getting Ready for Your Appointment

If you have not filled out your forms, please arrive 30 minutes prior to your appointment time and bring the following:

  • Current medication list
  • Photo ID
  • Insurance cards
  • Payment – If your insurance requires a co-payment, it will be collected at the time of service

Online Forms

Speed up you visit by completing the necessary forms below. For your convenience, download, complete and print the forms to bring to your appointment.

Patient Health Form

Download & Print

Registration Form (Adult)

Download & Print

Registration Form (Minor)

Download & Print

Financial Policy

Download & Print

HIPAA - Acknowledgement of Receipt and Notice of Privacy

Download & Print

Appointment Requests

Please note: We cannot process emergency requests through this form. If this is an eye emergency, please contact our office by calling 920-965-4700. If you are experiencing a medical emergency, please call 911.

To request an appointment, please complete the form below. Our office hours are Monday-Thursday 7:30am-5:00pm and Friday by appointment. We will contact you within 24 hours to confirm your request. Be advised that your appointment is not finalized until we have confirmed with you.

This form cannot be used to schedule same-day appointments. For same-day appointments or to schedule your appointment by phone, please call 920-965-4700.

Important: Please be aware this is a non-secure form of communication. Please do not include any personal medical information. If you have a medical question you would like answered by email, please log into your EyeClinic.net account.

Form Loading...

  • Monday
  • 7:30am - 5:00pm
  • Tuesday
  • 7:30am - 5:00pm
  • Wednesday
  • 7:30am - 5:00pm
  • Thursday
  • 7:30am - 5:00pm
  • Friday
  • By Appointment
  • Saturday
  • Closed
  • Sunday
  • Closed

920-965-4700
920-965-4701
  • 2020 Riverside Drive
  • Suite 201
  • Green Bay, WI
  • 54301
chatbot icon
chatbot icon

How can we help you today?

Request an Appointment 
Contact Us
View Office Hours
Online Patient Forms
 Back

Our Office

  • 2020 Riverside Drive
  • Suite 201
  • Green Bay, WI
  • 54301
920-965-4700
Contact Page Request an Appointment 
 Back

Office Hours

  • Monday
  • 7:30am - 5:00pm
  • Tuesday
  • 7:30am - 5:00pm
  • Wednesday
  • 7:30am - 5:00pm
  • Thursday
  • 7:30am - 5:00pm
  • Friday
  • By Appointment
  • Saturday
  • Closed
  • Sunday
  • Closed
Request an Appointment