Appointment Request

At Outreach Vision, we provide the highest quality service to all our patients. Use the form below to request your appointment. Please indicate your preferred date and time. Please note that we will reach out to you first to confirm your appointment or to provide you with an alternative date. You may also call us to request an appointment. Thank you!

Patient Type *

New PatientReturning Patient

This exam is for: *

Child Adult

Latest in Child Eye Care Is your child's vision getting worse?

If your child is myopic, showing signs of progression, or is at risk of myopia progression, Our eye doctor will discuss myopia management at your child upcoming eye exam. Feel free to contact us at (816) 858-6080 before your eye exam to learn more about this service or browse our website for further resources.

Reason for Appointment: *

Child is getting more nearsighted each year. Learn More Here Myopia Management or Control Ortho-K or CRT or GVSS (Vision Correction) Vision Therapy (Eye Therapy) Reading & Learning Problems in Children Lazy Eye (Amblyopia) or an Eye Turn (Strabismus) Child with Special Needs Attention or Concentration Problems Regular Eye Exam Contact Lens Exam Other

Reason for Appointment: *

Tearing or watery eyes Sensitive or rubbing eyes Eye Conditions and Diseases Headaches & Migraines Dizziness, Vertigo, Poor Balance Attention or Concentration Problems Post concussion, head trauma, stroke or brain injury Vision Therapy for Adults Regular Eye Exam Contact Lens Exam Other

Preferred Date & Times: *

Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.

Name: *

Phone: *

Email: *

How did you find us? *

Message:

Thank you. We will connect with you shortly to confirm your appointment.

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