Eye Surgeons and Consultants
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If you would like to schedule an appointment, please complete the fields below and someone from our office will contact you to confirm your appointment details.

Required information:

First Name:
Last Name:
Email Address:
Street Address:
Phone (day):
Phone (evening):
Best time to call:

Optional, but helpful information:

Reason for Appointment:
I am available for an appointment on:
Please do not request a "same day appointment" via this website.
Preferred doctor:
Type of insurance:

What should the doctor know about you?

This is not a secure contact form. Please do not include sensitive medical information in your appointment request that you would not normally feel comfortable sending over email.


By using this form you are submitting a request only. Until you receive either an e-mail from one of our schedulers or a telephone call, you do not have an actual appointment. Thanks for your understanding.


Eye Surgeons & Consultants:
4651 Sheridan Street, Suite 100
Hollywood, FL 33021
PH: (954)894-1500
EMAIL: info@myeyesurgeons.com




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