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Appointment Request Form

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

Thank you for contacting EyeCare of Vermont! Please fill out the form below and be sure to include notes if you have a specific request. We will contact you as soon as possible to schedule your exam.

Please note that Essex Junction is currently not scheduling new patient exams. You can request to be added to our active cancellation list, or schedule an appointment in our Burlington office. We apologize for any inconvenience.

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
  • This field is for validation purposes and should be left unchanged.