Request an Appointment

At Eye Therapy Vision Rehabilitation Center, 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!​​​​​​​

Reason for Appointment*

Preferred Date & Time*

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

Please let us know if you are a new or existing patient.

Patient Contact Information

By checking this box, you agree to receive SMS messages from Pupila Family Eyecare related to customer care. You may reply STOP to opt-out at any time. Reply to HELP to 281-7417295 for assistance. Messages and data rates may apply. Message frequency will vary” Learn more on our privacy policy page and Term & Conditions.
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