Request Appointment Request an Eye Appointment in Fort Lauderdale This is only an appointment request; it is not a final appointment until we confirm it with you. First Name * Last Name * Date of Birth * Phone Number * Email Address Patient status * Select one New patient Returning patient Reason for Visit * Select one Comprehensive eye exam Comprehensive eye exam + new contact lens fitting (never worn contacts) Comprehensive eye exam + contact lens evaluation (already wear contacts) Medical office visit (eye infection, irritation, dry eye, etc.) Free Myopia control consultation for children (virtual call) Free Kids Vision Screening (ages 5-17) Other Insurance or self-pay * Select one Self-pay VSP EyeMed Spectera Medicare Premier Eye Care Other Primary Holder Name Primary Holder Date of Birth Preferred Time * Morning (9:00 AM–12:00 PM) Afternoon (12:00 PM–2:00 PM) Late afternoon (2:00 PM–4:30 PM) Anything else we should know? (optional) How did you hear about us?
