Request an Eye ExamPatient Name*AddressZip Code*Phone*Email* Which location would you prefer to schedule an exam?Alexandria, MNBismarck, NDFargo, NDFergus Falls, MNGrand Forks, NDHutchinson, MNLittle Falls, MNMarshall, MNMinot, NDMontevideo, MNMoorhead, MNSt. Cloud, MNThief River Falls, MNVirginia, MNWadena, MNWahpeton, NDWilmar, MNWhat 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 SpecifyPlease use this space for any special requests of concerns
