Consultation/Ordering Eyeglasses Appointment Form

Name: North Country Eye Care
Address: 10 Benning Street, Suite 10, West Lebanon, NH, 03784, US
Telephone: 603-678-4759
Price range: $000 - $300

Please fill in the form below to setup an appointment.
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Phone*
Email*
Best Time to be Reached for Confirmation*

: Hours

Minutes

AM/PM
Comments
Comments
This field is for validation purposes and should be left unchanged.