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BrunswickEye Logo CMYK

BrunswickEye Logo

We are located at 283 Stadium Drive in Defiance

BrunswickEye Logo CMYK

BrunswickEye Logo

We are located at 283 Stadium Drive in Defiance

Home » Contact Us » Appointment Request Form

Appointment Request Form

Because of the pandemic, we are asking that you call the office to make appointments. You may still submit your patient forms to us. Thank you for your cooperation. 419-782-3937

Due To HIPAA Regulations: 

Any minor child under the age of 18 MUST have written consent from a parent or legal guardian in order to be treated at Brunswick Eye and Contact Lens Center.  Consent must also include the parent or guardian's consent for the minor to have Optos Imaging performed at the time of appointment.

Any NEW patient to Brunswick Eye and Contact Lens Center that is a minor child under the age of 18 MUST have a parent or legal guardian present with them at the time of the initial appointment.

Minor children without parental consent or without a parent or guardian present (when necessary) WILL NOT  be able to be treated at Brunswick Eye and Contact Lens Center at that time.

Thank You For Your Cooperation.