Make An Appointment

*IMPORTANT PATIENT SAFETY UPDATE: Please review our new COVID-19 policies.

Please note, the following Make An Appointment form is for non-emergent requests only. You expressly acknowledge and agree that this contact service will NOT be accessible during a medical emergency. If you are experiencing a medical emergency, seek care at the nearest emergency room.

Once you have successfully submitted our appointment form, a representative from Wilmington Eye will be in touch with you as soon as possible.

Name*
First Last
Phone Number*
Email Address*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Date Of Birth*
MM slash DD slash YYYY
Gender*
Time Frame for Appointment*
Procedure(s) of Interest?*
Have you had cataract surgery?*
- Yes
- No
- Unsure
Additional Information
By checking the box below you agree to the Terms of Use
I agree to the Terms of Use*
- I agree
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