Make an Appointment

To schedule an appointment at Killeen Eyecare Center, please fill out the following. Please note: Your exact appointment time and day will depend on availability. The Killeen Eyecare Center staff will contact you soon with your appointment details.

Personal Information
First Name:*		Last Name:*
Address:		City:
State:		Zip:
Home Phone:*		Work Phone:
Email:
Best way to contact:	Home Phone Work Phone Email	Best time to contact:	Morning Afternoon Evening
Insurance Provider:
Appointment Information
Reason for Appointment:
General Eye Exam Contacts or Glasses Vision Therapy Other
When would you like to schedule:		Urgent - First Available Within 2 Weeks
What time of day:		Select one Early Morning Morning Early Afternoon Late Afternoon
Comments:

*Required