Request Appointment

At Optique Vision, we provide the highest quality service to all our patients. Use the form below and we will connect with you to confirm your appointment or to provide you with an alternative schedule.

Fill out the form below or call us to schedule a same day appointment (518) 302-2106! Thank you!​​​​​​​

Patient's Name:
Patient's Phone Number:
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 $25 FEE FOR UNKEPT APPOINTMENTS UNLESS A 24 HOUR NOTICE IS GIVEN.

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