Vision Therapy Appointment Request

Name: Exceptional Vision
Address: 9000 SW 152nd Street, Suite 206, Palmetto Bay, FL, 33157, US
Telephone: 786-242-7755
Price range: $000 - $300

Vision Therapy Appointment Request Form

Please fill in the form below to request an appointment. This is only a request for an appointment, our office will contact you via text and/or email to confirm it has been scheduled

Type of Appointment
This appointment form is for Vision Therapy & Neuro-Optometric Rehabilitation. For Scleral Lenses, click Here. For General Eye Care, click Here.
Patient Type*
- New Patient
- Returning Patient
Reason For Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date and Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our Contact Us page.
Name*
First Last
Phone*
Email*
Best Time to be Reached for Confirmation

Hours :

Minutes

AM/PM
Name
This field is for validation purposes and should be left unchanged.