Appointment Request

Please provide the following information to request an appointment with one of our doctors. Our staff will be in touch shortly to confirm your appointment time.

Please let us know your name.

Please let us know your email address.

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Date of Birth

MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / Day01020304050607080910111213141516171819202122232425262728293031 / Year192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Invalid Input

Which doctor do you prefer to see?

No preferenceDr. Leila ChowDr. John FujiiDr. Linda HsuDr. Josephine Vo LaurelDr. Anthony NguyenDr. Yolanda ScheerDr. Kurt SkinnerDr. Rick Vanover Invalid Input

What day do you prefer for your appointment?

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What time of day do you prefer for your appointment?

Morning
Afternoon
Evening
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Please note that we cannot guarantee requested appointment dates due to doctor availability and scheduling. We will confirm a date when our staff contacts you.

Have you had an appointment with Brookside before?

Yes
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Basic Patient Information

Providing this information now will save time when you arrive for your appointment!

Choose your Vision Insurance Carrier...VSP (Vision Service Plan)Medical Eye ServicesSuperiorMedicareOtherCash Payment Invalid Input

Please note that Brookside Optometric Group does not currently accept any HMO coverage plans.

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Other Insurance

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Request Appointment