Please fill in the form below to setup an appointment.

Name*

First Last

Have been to our office for an exam previously?*

Yes
No

Date of Birth*

Phone*

Email*

Do you have any of the following conditions: diabetes (medicated or diet controlled), glaucoma, eye turn, lazy eye, or cataract?*

YES
NO

Unfortunately we cannot book an appointment for you at the moment. Currently, all Ontario optometrists are in a job action due to a breakdown in negotiations with the government, and have made the difficult decision to withdraw from delivering any exams that may be OHIP eligible at this time. (Please refer to https://www.saveeyecare.ca/ for more information.) You can seek eyecare, however, from: 1. Your family physician who can either treat you, or refer to an ophthalmologist, or to the on-call ophthalmologist if an emergency. 2. A walk in clinic who can refer appropriately if needed. 3. Emergency Department who can either treat you or arrange care from the on-call ophthalmologist.

Address*

Street Address Address Line 2 City Province Postal Code

Reason for Appointment*

Please provide a reason for your appointment. Details are stored securely and not sent by email. Please note this is not for emergencies or urgent issues.

Do you have insurance?*

Yes
No

Insurance Provider:*

Preferred Day of the week / Time of day*

Contact me by:*

phone
e-mail

Phone

This field is for validation purposes and should be left unchanged.

Appointment Request Form

Main Office Location