Appointment Request Please fill in the form below to setup an appointment.Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely.Preferred Date* Date Format: MM slash DD slash YYYY Preferred Time*8am-10am10am-12pm2pm- 3:30pm3:30pm - closePreferred Doctor*>>Select>>Dr. DugganDr. ClarkNo PreferencePatient Name* First Last Vision InsurancePlease bring all insurance cards with you to your appointment.Vision Insurance NamePrimary Member's Name First Last Member ID NumberPrimary Member's Date of Birth Date Format: MM slash DD slash YYYY Health InsurancePlease bring all insurance cards with you to your appointment.Health Insurance NamePrimary Member's Name First Last Member ID NumberPrimary Member's Date of Birth Date Format: MM slash DD slash YYYY Patient or GuardianPhone*Email* Best Time to be Reached for Confirmation*8am-10am10am-12pm2pm- 3:30pm3:30pm - closeCommentsOnce you submit an online appointment request, our office staff will notify you of available appointment times by text, email, and/or by phone. It’s that simple!PhoneThis field is for validation purposes and should be left unchanged.