Request an Appointment Online

Please fill out the following form if you would like to request an appointment online. We will contact you to confirm your appointment via your preferred contact method. If you are interested in an appointment within the next 24 hours, please call (816) 524-8900.

Appointment Request Form

* required field

* Person Requesting Appointment:
* Patient First Name:
* Patient Last Name:
* Patient Date of Birth:
* Type of Appointment
* Which Doctor would you like to see?

* What would be the best way to contact you? Phone Email
* Best Contact Phone:
* Contact E-mail:

1st Choice * First Preference Appointment Date:
* First Preference Appointment Time

2nd Choice * Second Preference Appointment Date:
* Second Preference Appointment Time

Other Comments

Lees Summit Eye Care, Eye Doctors and Optometrists at Eyecare Associates of Lees Summit, Missouri

Request an Appointment Online

Call for an Eye Doctor Appointment in Lee's Summit, MO at: (816) 524-8900