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Request an Appointment

Complete the form below to request an appointment with our office. Submitting this form does not guarantee an appointment time. A member of our staff will contact you to confirm availability.

Need immediate assistance? Call our office at (937) 433-0454.

Request An Appointment

Complete the short form below and our office will call you to complete scheduling.


For urgent eye problems, sudden vision changes, eye injuries, or severe eye pain, please call our office directly at (937) 433-0454.

Are you a new or existing patient?
New Patient
Existing Patient
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Please do not use this form for urgent or emergency eye problems. If you are experiencing a sudden loss of vision, severe eye pain, flashes and floaters with a curtain or shadow in your vision, or another eye emergency, contact our office immediately or seek emergency medical care.

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