Thank you for choosing Fort Madison Eye Clinic! We look forward to meeting you! You may now print and complete our New Patient Form prior to your appointment to expedite service. Please print the form, fill in the necessary information and bring it with you to your appointment. Or you may also send it by email prior to your appointment, so everything is ready to go upon arrival.

Printable PDF – New Patient Form

Please complete the form below and someone from our office will contact you shortly to confirm your appointment date and time. Please be aware that you are submitting a request only. Until a representative from our office has contacted you, you do not have an actual appointment.
We cannot schedule a “same day appointment” via this website, however, same day appointments may often be available. Please call the Fort Madison Eye Clinic office if you are interested in an appointment today.
Note: All required fields are marked *

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