Request an Appointment

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Request an Appointment

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You may easily request an appointment online, or by contacting one of our offices.

After you complete and submit the form below, someone from our staff will contact you within 1 business day to confirm the appointment time, date, and location.

While you're here, download your patient forms from our website and complete them before your appointment to ensure the shortest possible wait on the day of your exam.

Please complete the form below to request your appointment...

I am a:(*)

Please choose whether you are a new or existing patient of Primary Eyecare.
How did you find us?(*)

Invalid Input
Patient Name:(*)

Please enter your name.
Telephone Number:(*)

Please enter the best contact telephone number for you.
Email Address:

Please enter a valid email address.
Please contact me via:

Please choose how you would like to contacted to confirm your appointment.
What insurance will we be billing for you?(*)

Please tell us what insurance you will be using for your visit or if you will be paying out of pocket for your expenses.
Comments? (Note that this is a non-encrypted, non-confidential transmission.)

Please enter your comments.
Please choose your preferred location, day of the week, and appointment time slot below:

Note - Barracks Road is open Mon-Fri from 8:00am - 5:00pm except Wed. when we are open 12:00-7:00pm. Hollymead Town Center is open Mon-Sat. from 9:00am - 6:00pm, except Wed. when we are open 1:00-6:00pm.
Choose a location:

Please select a preferred location for your appointment.
Choose a day:

Please choose a preferred day of the week for your appointment.
Choose a time slot:

Please select your preferred time slot.

Primary Eyecare in Charlottesville, VA

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