Please use the following form to request an appointment. Our team will contact you promptly! Please fill in the form below to setup an appointment.Location* Eye & Ear Boynton Beach- Sunshine Square Plaza Eye & Ear Palm Springs - Greenwood Shopping Centre Eye & Ear Jupiter - Chasewood Plaza Eye & Ear Wellington - Wellington Town Square Eye & Ear Palm Springs - Palm Place Plaza Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred Date & Times*Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.Patient Type* New patient Returning patient Please let us know if you are a new or existing patient.Name* First Last Phone*Email* Best Time to be Reached for Confirmation* : Hours Minutes AM PM CommentsCAPTCHACommentsThis field is for validation purposes and should be left unchanged.