Appointment Request Form

Name: Buena Vista Optical
Address: 6455 S. Kedzie Avenue, Chicago, IL, 60629, US
Price range: $000 - $300

If this is an emergency, do not contact us via email, please use our emergency contact information.

To request your next appointment, please complete the form below and let us know the most convenient time and date for you. Please don't forget to include accurate contact details so we can follow up with you to finalize your request.

Please fill in the form below to setup an appointment.
We are no longer accepting NEW patients for BCBS IL Medicaid or Davis Vision patients. Current patients with this plan will still be accepted. All Medicaid patients, please be aware that there are only certain days and times available for appointments because not all of our doctors are Medicaid Providers. Please call Buena Vista Optical to schedule an appointment at: 773-863-9234.
Doctor
Reason for Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page. We are no longer accepting NEW BCBS IL or Davis Vision patients. Current patients with these plans will be accepted. All Medicaid patients, Please be aware that there are only certain days and times available. Please call the Buena Vista Optical to schedule an appointment.
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
Name
This field is for validation purposes and should be left unchanged.

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