Appointment Request

Confidentiality Notice This e-mail form is not intended for the transmission of personal health information. E-mail is not a secure form of communication and any personal information provided by the sender is sent at his or her own risk. Please be aware that your employer or Internet service provider may have access to your e-mail. If you would rather not use e-mail, please contact Washington Pacific Eye Associates by phone. Thank you!

If you would like to make an appointment with Washington Pacific Eye Associates, please call us at (425) 889-2020, or make your appointment online by filling out the form below.

After submitting this form, we will confirm your appointment. Prior to your visit, please update your medical records if you have already registered with our online medical records system or, if you are a new patient or have not yet registered, please register here and enter your medical history (we will provide you with a security code for the registration process).

First Name

Last Name

E-MAIL

Your phone

Preferred Day

Preferred Time

Reason for Appointment

Selecting the SEND button will send an e-mail message to Washington Pacific Eye Associates. If you do not receive an e-mail confirmation in 24 hours, please make sure it is not in your spam folder.

Address

134 Central Way Kirkland, WA 98033

Call Us

425-889-2020

Email Us

kirklandeye@gmail.com