Schedule an Appointment

Use this online form to begin the scheduling process with New England Eye. Fill out the required fields and a representative will contact you to confirm your information.

Patient Information

Health Insurance:

Is the patient the primary subscriber?

Appointment Information:

*Preferred Location

Eye Care Services:




Desired Appointment Date:

Pick date

Desired Appointment Times:



Optional

Is this your first time at New England Eye?

How did you hear about New England Eye?:

Is this appointment for:

Any additional comments?

Confidentiality Notice

The appointment request form requires you to provide information that is needed to complete your request for an appointment and shall be utilized by New England Eye only for the purpose of helping you secure an office visit. Your information will be transmitted by e-mail and will not be secured by encryption software. By completing and sending the form you accept the risk of sending confidential information via e-mail and agree not to hold New England Eye or any of its affiliates, employees or agents liable for any damages you may incur, directly or indirectly, as a result of the transmittal of your information. You are welcome to telephone New England Eye to make your appointment.

 

Click here for New England Eye's Complete Privacy Policy.