Make an Appointment

Submit the form below to request an appointment. Our staff will contact you shortly to schedule and confirm the exact date and time.

Contact Information
Please provide current contact information so that we can contact you to confirm your appointment.
Name*
Phone*
Email*
Patient Status*
- New Patient - I have NOT been seen by Dr. Brent, Dr. Bethany, or Dr. Foreman in the past
- Existing Patient - I have been seen by Dr. Brent, Dr. Bethany, or Dr. Foreman in the past
Date & Times
Our team will be happy to assist you in finding the earliest available appointment for your annual eye exam. If you are scheduling an appointment for a more urgent medical eye concern, please call our office directly at (515) 955-7777 instead of using this website request.
Preferred Date*
MM slash DD slash YYYY
Alternate Date
MM slash DD slash YYYY
Time*
Comments
Important: Please note that the date and time you requested may not be available. We will contact you to confirm your actual appointment details.