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Contact Us :: SITE LAST UPDATED: Nov 2, 2008  
Appointments
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Appointments

If you would like to schedule an appointment, please complete the fields below and someone from our office will contact you soon to confirm your appointment details.

Please be aware that you are submitting a request only. Until you receive either an e-mail from one of our schedulers or a telephone call, you do not have an actual appointment. 

In addition, please understand that you are submitting this request over the Internet. Do not include any sensitive medical information in your appointment request, for we cannot guarantee that it will not be seen by other parties.

Please do not request a "same day appointment" via this website.

Required information:

Title:
First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip:
Phone (day):
Phone (evening):

Optional, but helpful information:

Reason for Appointment:
I am available for an appointment on:
What is the best time for us to contact you?
Your Optometrist:
Preferred doctor:
Preferred location:
Type of insurance:

What should the doctor know about you:

Meet the Doctors
·  Paul J. Befanis, MD
·  Rafael Trespalacios, MD
·  Daniel J. Lutz, MD
·  David J. Strunk, OD
·  Mark R. Fisher, OD
·  Camilla J. Quirie, OD
·  David D. Hendrix, OD
·  Dominic J. Pastore, OD
·  Paula S. Mintchell, OD
·  Shea Eagerton, OD
News
·  Welcome
·  Read about our news
Affordable Payment Options
·  Affordable Payment Options
Links
·  We have links to several other sites that may help you
Appointments
· Schedule a consultation with our doctors. Tell us when you would like to visit.
Updates & Patient Forms
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Email:

· Patient Forms

 
Locations

VISIT US AT: 665 Apollo Boulevard Melbourne Florida 32901
PH: 321-984-3200 | FAX: 321-984-0032 EMAIL: appointments@brevardeye.com

 
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