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St. Luke's Clinic

Dr. Gills named one of America's Top Doctors

Dr. Gills presented with Humanitarian Award

Make an Appointment

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We see patients Monday through Friday beginning at 7:00 am. To make an appointment to see one of our doctors at St. Luke's please:

Fill out the online appointment request form or...

Call: (727) 938-2020 ext:2275

1-(800) 282-9905 ext:2275

Our operator will ask you for:

A description of your eye problem.
Your name, address, Social Security and phone number.
Your insurance information.

Online Appointment Request Form

Please read our Privacy Statement prior to completing this appointment form.

Welcome to St. Luke's on-line appointment request system. To request an appointment, please enter the information requested and then click on the "Submit" button at the bottom of the page. We will contact you, usually within 2 business days, with our recommendation for the best specialist for your problem, along with a proposed appointment date and time.

First name
Middle initial
Last name
Date of birth
Email
Daytime phone	Area code:-

Please choose 2 appointment dates, in order of preference, that you prefer.

First choice:
1.

Second choice:
2.

What time of day would you prefer? (check one)

Morning Afternoon Either

Which St. Luke's location would you like to schedule an appointment for?
Tarpon Springs Main Office 43309 US Hwy. 19 N. Tarpon Springs, FL 34689	Spring Hill Seven Hills Center 1180 Mariner Blvd. Spring Hill, FL 34609

St. Petersburg
9400 9th St. N.
St. Petersburg, FL
33702

Bayonet Point
Summit Medical Center
7509 State Rd. 52
Suite 110
Bayonet Point, FL 34667

Have you ever been a patient at St. Luke's before? yes no

If so, approximately when:

Reason for your visit and/or additional information that you wish to provide us:

Do you wear contact lenses? yes no

If you will be using insurance coverage for this visit, please indicate your carrier(s):

Primary:		HMO?yes no
Secondary:		HMO?yes no

If your insurance is an HMO, who is your primary care physician?

How would you like us to confirm your appointment?

phone - preferred and fastest method of confirmation (be sure that you filled in the "phone #" field at the beginning of this form)
e-mail (be sure that you filled in the "email" field at the beginning of this form)

Before submitting this appointment request with the button below, please re-read your entries to ensure that your information is accurate and read the following privacy statement.

The information you supply via this appointment form is considered strictly confidential and will never willingly be shared with anyone without your explicit permission. Some people are concerned about information on the Internet being "hijacked" by hackers. This concern may be valid not only for the Internet, but for any communications by any method, be it wireless telephone, a cell phone, a FAX machine or any other communications device. Although this web page is protected by 128 bit encryption security, St. Luke's cannot guarantee the security of the information you submit using this form as it pertains to electronic transmittal. If you deem the information we ask for to be sensitive, the only way to ensure its absolute security is to discuss it with the doctor face-to-face. We encourage you to do so by requesting an appointment by phone.