Appointment Request Form

Vision Insurance/ Insurance (if any):
Insurance Number:

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
  • Highland Optometrics

    Terry Clayville,O.D.
    Mark Stinson,O.D.

    7291 Boulder Avenue
    Suite 2D
    Highland, CA 92346