Eye Surgeons and Consultants
 
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Appointments

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:

Title:
First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip:
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
FX:(954)894-1526
EMAIL: info@myeyesurgeons.com

 

 

 

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