Request an Eye Exam Patient Name* Address Zip Code* Phone* Email* Which location would you prefer to schedule an exam? Alexandria, MN Bismarck, ND Detroit Lakes, MN Fargo, ND Fergus Falls, MN Hutchinson, MN Little Falls, MN Marshall, MN Minot, ND Montevideo, MN Moorhead, MN Morris, MN St. Cloud, MN Thief River Falls, MN Virginia, MN Wadena, MN Wahpeton, ND Wilmar, MN What day do you prefer your appointment?* Monday Tuesday Wednesday Thursday Friday Saturday Sunday What time of day works best for you?* Morning Midday Afternoon Purpose of Visit* Annual Exam Eyeglasses Contacts Prescription Sunglasses Other Specify Please use this space for any special requests of concerns
