Contact Us

Appointments

If you would like to schedule an appointment, please complete the fields below and someone from our office will contact you soon to confirm your appointment details.

Please be aware that you are submitting a request only. Until you receive either an e-mail from one of our schedulers or a telephone call, you do not have an actual appointment.

In addition, please understand that you are submitting this request over the Internet. Do not include any sensitive medical information in your appointment request, for we cannot guarantee that it will not be seen by other parties.

Please do not request a "same day appointment" via this website.

Required information:
Title:
First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip:
Phone (day):
Phone (evening):
Best time to call:
Optional, but helpful information:
Reason for Appointment:
I am available for an appointment on:
Your Optometrist:
Preferred doctor:
Preferred location:
Type of insurance:
What should the doctor know about you:

University Club Tower, Ste 550, 1034 South Brentwood Blvd.,
Saint Louis, MO 63117
PH: 314.863.9966 | 877.718.2020 | FAX: 314.863.9977
EMAIL: info@surevision.us
Find us in the Saint Louis, Hazelwood, Alton, Maryville,
St. Charles, Creve Coeur and Granite City areas.

Refractive Surgery :: Senior Eye Health :: Eye Conditions :: Patient Forms :: Events :: News :: Why Choose Us? :: Doctors :: Cosmetic

Contact Us

Appointments

Required information:

Optional, but helpful information: