New Patient Form

Schedule Appointment

NOTE: If you are a new patient, please also fill out the New Patient Information Form here.

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First Name*

M.I.*

Last Name*

Email Address*

Primary Phone Number*

Secondary Phone Number

Date of Birth*

Social Security Number

Address*

Street Address Address Line 2 City State ZIP Code

Gender*

Race*

Employer

Occupation

Do you wear contact lenses?*

Marital Status

Spouse's Name

Spouse's Date of Birth

Spouse's Employer

Medical History

Primary Care Physician

Primary Care Physician’s Phone Number

Please check if you have any of the following conditions:*

Diabetes

Glaucoma

Macular Degeneration

None of the above

Primary Insurance

Note: Please still bring all insurance cards with you to your appointment!

Responsible Party (Insurance Subscriber)

Member’s Date of Birth

Member’s SSN

Member’s Primary Phone Number

Member’s Address (if different from patient’s)

Street Address Address Line 2 City State ZIP Code

Privacy Policy

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Health Information Protection**

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Testimonials

    
 
 
       B R 
 September 27, 2026
 
 
  I always get treated with respect and have a top notch experience every time I go in for an appointment! Keep up the good work!
  
 
      S B 
 September 25, 2026
 
 
  Very fast, I checked in at 1:20 for my 1:45 appointment and Sara helped right away and  was very friendly and helpful. Very kind and helpful office.
  
 
      D 
 September 25, 2026
 
 
  Sara was grate! My son definitely enjoyed talking with her.
  
 
      R W 
 September 25, 2026
 
 
  Very friendly staff very helpful. Dr. Johnson is probably one of the nicest guys I think I’ve ever met a great place to have your eyes worked on.
  
 
      D B 
 September 25, 2026
 
 
  Sara and Laura were very kind and respectful. Even when we were having issues with the technology not wanting to function properly, they were quick to figure out what to do to get me moving with my exam. Definitely will be coming back to this location!
  
 
      S M 
 September 24, 2026
 
 
  Great people! Customer friendly! In quick!
  
 
      K 
 September 24, 2026
 
 
  Sara was great as well as Dr Baldwin
  
 
      J S 
 September 22, 2026
 
 
  Everyone was exceptional!! From start to finish I had the very best experience.
Thank you
  
 
      C W 
 September 22, 2026
 
 
  Does this place take VSP insurance?
  
 
      C W 
 September 20, 2026
 
 
  Caring and professional.

New Patient Form

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New Patient Form

Medical History

Primary Insurance

Privacy Policy

Testimonials

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Schedule Now at Sedalia

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