Make an appointment: (519) 426-3123
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Our team
Vision info
Contact us
Appointment Form
Appointment Form
SOI 6860
2015-04-06T15:13:44+00:00
Referred by
Title
Mrs
Miss
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First Name
*
Last Name
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Phone ((###)###-####)
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Alternate phone number ((###)###-####)
Email
*
Date of birth
*
Age Range
Please choose
0-18
18-44
44-64
65+
Are you a contact lens wearer?
*
Yes
No
Doctor
Dr. Michael Zona
Dr. Linda Hadaller
Dr. Amber McKnight
Dr. Allison VanBerlo
Preferred day
*
Please note that one of our representative will join you to confirm or to propose a more suitable date.
Hour
*
AM
PM
Message/comments
Phone
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Contact Info
100 Colborne Street N
Simcoe, ON N3Y 3V1
Phone:
519-426-3123
Fax: 519-426-8594
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