Appointment Request Form

Vision Insurance/ Insurance (if any):
Insurance Number:
I would like an appointment with:

Please select up to 3 appointment dates / times.
If you can't find a convenient appointment time, please call our office

Enter Letters Shown

Please Note: The requested appointment time(s) may no longer be available. We will contact you to confirm your actual appointment date and time.

Practice Photo
.
  • Wentz Eye Care, PA

    Monte Wentz, O.D.

    135 East 6th St.
    Suite 101
    Concordia, KS 66901

    785-243-3937