Welcome to Clear Lake Optometry on-line appointment request system.  To request an appointment, please enter the information requested and then click on the "Submit" button at the bottom of the page.  We will contact you, usually within 2 business days.

First: MI:
Last:
Date of birth Email:
Daytime phone: Area code:-
Evening phone: Area code:-

Please choose 2 appointment dates, in order of preference, that you prefer.
First choice:
 
Second choice:

What time of day would you prefer?  (check one)
Morning       Afternoon        Either

Have you ever been a patient at Clear Lake Optometry before?  yes   no
If so, approximately when: 

Additional information that you wish to provide us:


How would you like us to confirm your appointment? Please check to make sure you entered either your phone number or your email address in the fields at the top of this form.
phone - preferred and fastest method of confirmation

e-mail

Before submitting this appointment request with the button below, please re-read your entries to ensure that your information is accurate.

  
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