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Appointment Request Form

If this is an emergency, do not contact us via this form. Please use our emergency contact information.

Thank you for contacting EyeCare of Vermont! Please fill out the form below and be sure to include notes if you have a specific request. We will contact you as soon as possible to schedule your exam.

Please note: Due to extended wait times for appointments, EyeCare of Vermont is not currently scheduling new adult patients.

Parents/guardians are welcome to fill out appointment requests for new pediatric patients. Please specify if your request is for a child under 18 years of age, or if you are a family member of an established patient.

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
  • This field is for validation purposes and should be left unchanged.