203 S 16th St, Clarinda, IA 51632
(712) 542-6521
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We care for people, not just eyes
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Appointment Request
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Appointment Request
Our business hours are Monday – Friday, 9:00 am to 5:00 pm.
To request an appointment, please complete the form below and a member of our staff will contact you shortly. The information you submit is secure and kept confidential at all times. Please note you do not have an appointment until you receive confirmation from us.
Name
*
First
Last
Patient Type
New Patient
Current Patient
Returning Patient
Phone
*
Email
*
Enter Email
Confirm Email
Preferred Appointment Date
*
Date Format: MM slash DD slash YYYY
Preferred Time of Day
*
Morning
Afternoon
Evening
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