Appointment Request

**Please note Items marked with an asterisk (*) are required to complete your request

 

* Office location Oviedo Port St. John
* Name
Address
City
State/Province
Postal Code
* Phone
* Email
How would you prefer we contact you?
When would you prefer we contact you?
How were you referred to us?  
If you were referred by an existing patient, can you please let us know their name so we can thank them?

Requested Appointment Date / / (month/day/year)
Requested Time Range: Between and
Which doctor would you prefer to see? 
Reason for visit:

Other comments or questions:

Type the security word eyes and click the Submit button
* security word:

Non-emergency and routine appointments are usually made in advance, though we do accept walk-in patients if time is available. 

 

Appointment RequestIf you have a medical concern or emergency, call us as soon as possible and we will try our best to see you quickly.  As a courtesy to all our patients, we strive to run on time. 

 

We reserve the right to reschedule or cancel patients who arrive 15 minutes or more later than their scheduled time.  If you are running late, please notify our office as soon as possible.


Please give our offices 24 hours advanced notice if you need to cancel or reschedule, so we may open up your time slot to other patients needing emergency or walk-in care and attention.


If you are a new patient to our office, we highly recommend visiting our Forms page to download, print and fill out your forms before arriving at our office.  Otherwise, we advise arriving 20 – 30 minutes prior to your appointment time to ensure you have enough time to complete your forms.


We look forward to seeing you during your visit!  Please contact us or use the form to the right to request an appointment and we'll get back to you as soon as possible.

 

PLEASE NOTE:  All appointment times are subject to availability.  We will do our best to accommodate your request but cannot guarantee specific appointment times or doctors.  Our office will contact you via email or telephone to confirm your appointment promptly.