Appointment Request Form

Request An Appointment | Modern Eyes Optometery – Cerritos, CA

Our weekday late and weekend exam appointments are very popular, so please have flexibility if you are seeking one of the high-demand appointment times.

Our online appointment request service is NOT for eye health emergencies.  If you are experiencing an eye emergency – e.g. sudden loss of vision or eye injury – call us at (562) 809-2020 immediately.  If it is outside our office hours, please call 911 or go directly to the emergency room.

Appointment Request Form

Your Name (required)

Your Email (required)

Your Phone Number (optional)

Reason for Appointment (optional)

Insurance (optional)

Details (Please specify at least one Date and Time for your request)