Clarity Eye Care Appointment

Preferred Day and Time

Specific Date?

Preferred Office Location

Reason for Visit

Enter Special Requests or Comments Below:

Patient Name(s):

Relationship to Patient::

First Name:

Last Name:

Address:

Home Phone:

Work Phone:

Best Time To Call:

Morning

Afternoon

Your email address:

Mobile/Other::

Request An Appointment

New and returning patients can request an appointment at any time.

Simply fill out the form below

Visual Acuity:
What is 20/20?

Protecting Your
Eyes

Children's Vision

Computer Vision
Syndrome

Contact Lens Care

Sports & Vision

CLARITY EYE CARE

Welcome To

CALL TODAY (509) 836-2818

Have an Appointment?

If you would like.
Please print and fill out the
Patient History Form
Patient History Form (in Spanish)
and bring it with you for your eye
exam.