Appointment Request Form

Name: Norwalk Vision Center
Address: 148 East Avenue, Suite 3C, Norwalk, CT, 06851, US
Telephone: 203-866-3280
Price range: $000 - $300

If this is an emergency, do not contact us via email, please use our emergency contact information.

Complete the following form:

Please fill in the form below to setup an appointment.
Reason for Appointment
- Eye Exam
- Contact Lenses
- Medical Exam
- Specialty Contact Lens Consult
- Ortho-K Consult
- Other
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Phone*
Email*
Best Time to be Reached for Confirmation*

: Hours

Minutes

AM/PM
Comments
Email
This field is for validation purposes and should be left unchanged.