Appointment Request

Use this form for non-urgent appointments only.
For urgent appointments within 24 hours, please contact us by phone 516-616-1710.

We participate with most local and many national insurance plans. However, it is the responsibility of the patient to understand whether their insurance has limits on the doctors they can see or the services they can receive. Depending on your insurance coverage, you may be responsible for co-payments, co-insurance, or other deductible amounts.

Our affiliation with various insurance providers does change randomly; if you have any concerns regarding your coverage please contact your insurance carrier or our office 516-616-1710.

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Patient Information

* First Name:
* Last Name:
Address:
City:
Zip Code:
Home Phone:
Mobile Phone:
Work Phone:
Best time to contact you: Select a time Morning Afternoon Evening
* Email:

Appointment Information

Patient Status: Select a status I'm a new patient I'm an existing patient
Requested Examination: Select exam type Annual Visit Consultation Eye Glasses Routine Checkup Second Opinion
Referring Physician:
Preferred Day Select a day Monday Tuesday Wednesday Thursday Friday
Preferred Time Select a period 48-72 Hours One Week Two Weeks Three Weeks
* Insurance Provider:
Please enter your insurance carrier and the participating plan type. Refer to the "Insurance Plans" reference noted above for more info.
Questions/Comments:

Thank you for contacting our Floral Park Ophthalmology practice. A member of our staff will be in touch with you soon.