Schedule An Appointment
Scheduling an appointment with our physicians is now easier than ever. Complete all of the fields below and select the "Submit" box. Someone from the doctor's office will reply and confirm your appointment time within three business days.
Please note: This service is for the Northeast Florida Center for Advanced Dry Eye Care Center only.
By submitting your request via this Web page, you are authorizing us to confirm the appointment using the e-mail address you provide below.
New Patient
First Name
Last Name
Last NameHome AddressCity ZipCode
City ZipCode Date of Birth Last 4-digits SS#
Last 4-digits SS# Home Phone #Work # Cell #
Work # Cell # Email address
Insurance Company
Street Address
City, State, ZipCode
Member ID #
Perferred Date #1at
at Perferred Date #2 at
atPerferred Date #3at
at Please give a brief description of your symptoms 
