Skip to content
Find Us at Blaine
Book Appointment
(763) 309-8587
Home
About Us
Meet Our Staff
Our Eye Doctor
Eye Care Services
Comprehensive Eye Exams
Pediatric Eye Exams
Dry Eye Treatment
Eye Disease Management
LASIK Co-Management
Eyeglasses
Contact Lenses
Contact Lens Exam
Order Contact Lenses
Patient Center
Insurance
Online Payment
Hours & Location
Appointment Request Form
Thanks for contacting us! We will get in touch with you shortly.
Please fill in the form below to setup an appointment.
Reason for Appointment
*
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date & Times
*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type
*
New patient
Returning patient
Name
*
First
Last
Phone
*
Email
*
Best Time to be Reached for Confirmation
*
Hour
Minute
AM
PM
AM/PM
Comments
Submit