Make an Appointment

Feel free to take a moment to request an appointment. You should receive an email from “support@applevalleyvision”, to schedule and confirm your appointment within 1-2 business days, if you don’t see one it may be your junk mail folder. If this is for anything other than a routine annual exam, please contact us directly via call/text. We look forward to hearing from you!

Contact Information
Please provide current contact information so that we can contact you to confirm your appointment.
Name*
First Last
Phone*
Email*
Patient Status
- New Patient
- Existing Patient
Insurance
Provide the name of your Insurance company. Please do not list any policy or ID numbers.
Vision Insurance Carrier
Medical Insurance Carrier
Date & Times
Please be aware that appointments must be requested at least 1 day(s) in advance.
Preferred Date*
MM slash DD slash YYYY
Alternate Date
MM slash DD slash YYYY
Time*
Comments
Important: Please note that the date and time you requested may not be available. We will contact you to confirm your actual appointment details.