Appointment Request Form Call a Location Request an Appointment NOTE: If you are a new patient, please also fill out the New Patient Information Form here. Request An Appointment "*" indicates required fields First Name* Last Name* Phone*Email* Patient Type*New PatientReturning PatientAppointment InformationPlease provide your appointment preferences below. Please note, your appointment is not finalized until a member of our team has reached out to confirm your appointment details directly. Choose a Location*ClintonLee's SummitSedaliaWarrensburgBelton (Innovative Vision Care)Type of ExamRoutine Vision ExamContact Lens ExamMedical Emergency / Follow UpPreferred Doctor*No PreferenceDr. Jason LakeDr. Susan LakeDr. Brett LiesemeyerDr. Kyle JohnsonDr. Jill McNaughtonDr. David OrsonDr. Andrew YeagerDr. Katelyn HardyDr. John DrenonDr. David BaldwinDr. Aaron LawDr. John GelvinDr. Kelsey StarmanAppointment Time*No PreferenceMorning AppointmentAfternoon AppointmentEvening AppointmentAppointment Date* MM slash DD slash YYYY Insurance Plan Additional CommentsQuestions & CommentsIf you need to cancel your appointment for any reason, please contact us 24 hours before your appointment time. You can cancel your appointment by calling our office.EmailThis field is for validation purposes and should be left unchanged. Testimonials
