Book Virtual

6718 Lake Nona Blvd, Suite 140
Orlando, FL 32827
(407) 857-3937

Fax: (407) 392-0420

Monday-Thursday
8:30 a.m. – 5:00 p.m.

Friday
8:30 a.m. – Noon

We’re committed to providing the very best experience for patients.

To request a virtual appointment online, use this form or give us a call at 407.857.EYES (3937).

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Birthday*
MM slash DD slash YYYY
Contact Reason*
Comments / Message
Appointment Request Information
Fill in the information below to request your appointment date and time.

Note: Selecting a date/time on this form does not guarantee your appointment will be at your requested time. We will do our best to accommodate you and we will contact you directly with our closest matching appointment times for confirmation.
You appointment is not confirmed until we verify it with you.
This appointment is for a:*
- New Patient
- Returning Patient
Would you like this appointment to be in-person or via telemedicine?
Requested Date*
MM slash DD slash YYYY
Requested Time*

: Hours

Minutes

AM/PM
Describe Your Reason for an Appointment*
Privacy Policy & Terms of Use*
- I have read and agreed to the privacy policy and terms of use for Lake Nona Ophthalmology.
Email Updates
- I would like to receive occasional email updates and announcements from Lake Nona Ophthalmology.
Comments
This field is for validation purposes and should be left unchanged.

Appointment Request Information