Make An Appointment

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

The following form is for non-emergent appointment requests only. By submitting this form, 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. If it is outside normal business hours and you are having an eye emergency, please dial 910.763.3601 and follow the prompts to reach our on-call ophthalmologist.

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
Age
Gender
Time Frame for Appointment*
Procedure(s) of Interest?*
Please Explain Procedure Interest
Additional Information
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