Appointments

If you would like to schedule an appointment, please complete the fields below and someone from our office will contact you soon to confirm your appointment details.

Please be aware that you are submitting a request only. Until you receive either an e-mail from one of our schedulers or a telephone call, you do not have an actual appointment.

In addition, please understand that you are submitting this request over the Internet. Do not include any sensitive medical information in your appointment request, for we cannot guarantee that it will not be seen by other parties.

Please do not request a "same day appointment" via this website.

Required information:
Title:
First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip:
Phone (day):
Phone (evening):
Best time to call:
Optional, but helpful information:
Reason for Appointment:
I am available for an appointment on:
Your Optometrist:
Preferred doctor:
Preferred location:
Type of insurance:
What should the doctor know about you:

VISIT US AT: 7427 Lake Street, River Forest, IL 60305
PH: 708-771-3334 | 1.800.KIRKEYE (547-5393) | FAX: 708-771-0841 EMAIL: info@kirkeye.com

·	Scott H. Kirk, M.D.
·	Kent A. Kirk, M.D.
·	Dean Bauer, O.D.

·	Read about our news
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·	Speakers Bureau

·	Learn about the flexible monthly payment option offered to patients.

·	We have links to several other sites that may help you

·	Schedule a consultation with our doctors. Tell us when you would like to visit.

Appointments

Required information:

Optional, but helpful information: