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KOA Appointment Request Form

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

To request your next appointment, please complete the form below and let us know the most convenient time and date for you.  Please don't forget to include accurate contact details so we can follow up with you to finalize your request. Please note that our ophthalmic surgeons do not accept appointment requests.

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
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  • This field is for validation purposes and should be left unchanged.

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WELLS OFFICE UPDATE: The eyeglass department at our Wells location is temporarily closed due to staffing issues.

The office remains open for eye exams and medical visits. We plan to return to full operation as soon as we are able.