Appointment Request to the Fresno offices of Eye-Q Vision Care

If you would like to schedule an appointment, please complete the fields below and someone from our office will contact you soon to confirm your appointment details.

In addition, please understand that you are submitting this request over the Internet. Do not include any sensitive medical information in your appointment request, for we cannot guarantee that it will not be seen by other parties.

Full Name*
E-Mail Address*
Street Address
City
State
Phone (Day)
Phone (Evening)
Best time to call
Optional, but helpful information:
Reason
I am available on
Your optometrist
Preferred doctor
Preferred location
Type of insurance
What should the doctor know about you?
Please be aware that this is a non-secure communication.