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We’re inside the Douglasville Sam’s Club Optical at 6995 Concourse Pkwy, Georgia.

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Vision gives us the
power to dream big!

Vision gives us the
power to dream big!

Home » Contact Us » Appointment Request Form

Appointment Request Form

This appointment request form is for NON-URGENT care. Please call or text our office directly at 770-917-2221 if need faster assistance. For emergencies, please call 911 or find the nearest urgent care center.

  • Please fill in the form below to setup an appointment.
    Please check all that apply. **PLEASE NOTE: If this is an urgent visit, we recommend contacting our office by calling or texting 770-917-2221. Response to requests may take 48-72 hours.
    Please let us know what day(s) and time(s) you would prefer to have your appointment. THIS IS NOT A GUARANTEE OF YOUR APPOINTMENT UNTIL OUR STAFF CONTACTS YOU AND CONFIRMS IT BY PHONE, TEXT OR EMAIL.
  • Please let us know what day(s) and time(s) you would prefer to have your appointment. THIS IS NOT A GUARANTEE OF YOUR APPOINTMENT UNTIL OUR STAFF CONTACTS YOU AND CONFIRMS IT BY PHONE, TEXT OR EMAIL.
    Please let us know if you are a new or existing patient.
    Insurance appointments may take up to 3-5 business days for verification. We will contact you by phone, text or e-mail if we cannot confirm your insurance. Please click on the following link to confirm the insurances that we accept. Insurance must be verified and eligible before the appointment is made.
    If you are not the primary on the insurance, please put the name of the primary in the next box.
  • You must bring a valid ID and insurance card to your appointment in order to use your insurance. Please call or text our office at 770-917-2221 if you have any questions.
  • If you do not have the ID, we will not be able to verify, and it will delay the appointment request.
    PLEASE NOTE: If you prefer a faster response, please allow our office to communicate by text. Texts are subject to charges/fees by your carrier that are paid by subscriber.
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  • PLEASE NOTE! If you do not get a confirmation after pressing submit, please check your email is correct and resend or contact us.
    You are required to read the COVID-19 Protocol. For FOR NEW PATIENTS, in order to be seen at our clinic, you must complete the online form BEFORE the appointment. Please check Yes or No if you agree to the requirements. If you check No, we will place your name on a reserve list when we are able to lessen our restrictions on safety guidelines recommended by the CDC and AOA.
  • This field is for validation purposes and should be left unchanged.
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MASK WEAR WILL BE REQUIRED. We are open by APPOINTMENT ONLY or text at 770-917-2221. In order to be seen for the appointment, you must read and stay up to date on our COVID-19 pandemic protocols Read Our COVID Guidelines Post…