Request Appointment

At Optique Vision, we provide the highest quality service to all our patients. Use the form below and we will reach out to you within 24 hours to finalize a convenient available appointment for you.

​​​​​​​Please note that the appointment time you request below is only a request, we will reach out to you by text, email or phone call to confirm an available time slot. For urgent medical appointments please call 518-302-2106. Thank you, we look forward to serving your eye care needs!

Patient's Name:
Patient's Phone Number:
Patient's Address:
Patient's Email:
Patient's Date of Birth:
Note if New or Previous Patient:
Insurance Name:
Insurance ID Number
Insurance primaries Name and Date of Birth:
Insurance primaries place of employment
Reason for appointment
Preferred Doctor
Preferred Day and/ or Time of Day


​​​​​​​Please Note: THERE WILL BE A $35 FEE FOR UNKEPT APPOINTMENTS UNLESS A 24 HOUR NOTICE IS GIVEN.

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