Clarkson Eyecare - Schedule an Appointment

Please choose one of the following options to schedule your appointment online:

I am an existing Clarkson Eyecare patient, you have my email address on file, and I would like to set up a Patient Portal account.
* Having been previously seen by a Clarkson Eyecare doctor does not necessarily mean you have a Patient Portal account. These accounts contain Personal Health Information (PHI). In order to protect your identity, you must have a valid email address on file with Clarkson Eyecare.

Office Location:


	Title
*	First Name
*	Last Name
*	Gender
*	Address 1
	Address 2
*	City
*	State
*	Zip
*	Home Phone
	Work Phone
	Cell
*	Email Address
*	Date of Birth	Please use MM/DD/YYYY format, eg. 12/30/1965
*	Social Security # (valid # required)	- -
	Preferred Language
*	Insurance Company	If your insurance company does not appear here, please call 888.EYECARE to schedule your appointment.
	Subscriber Name
	Subscriber Date of Birth	Please use MM/DD/YYYY format, eg. 12/30/1965
	Patient Relationship to Subscriber
	Subscriber Sex
	Subscriber Social Security # (valid # required)	- -
	Subscriber Employer
	Subscriber Insurance ID
	Group Number
	Carrier Service Phone Number