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
Title
Mrs
Miss
Mr
First Name
*
Last Name
*
Phone Number
*
(### - ### - ####)
Email
*
Date of birth
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Are you a contact lens wearer?
*
Yes
No
Preferred Doctor
Dr. Michael Zona
Dr. Linda Hadaller
Dr. Amber McKnight
Dr. Allison VanBerlo
Preferred day
*
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Day
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Year
2020
2019
2018
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2014
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2012
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2002
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1971
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1963
1962
1961
1960
1959
1958
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1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Can we phone you to book this appointment?
Yes, please
No, thank you, I prefer email
Hour
*
7:45AM-10AM
10AM-12PM
12PM-2PM
2PM-4:30PM
4:45PM - THURSDAY ONLY
Referred by
Message / Comments
I am a
*
Existing Patient
New Patient
If you are a NEW PATIENT, the 2 additional fields below must be completed, thank you.
Address
*
Please include full mailing address, including PO Box numbers and postal code.
Health Card #
*
Please include the *** full 10 digit number, *** the 2 letter version code and *** the expiry date.
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
Make an appointment
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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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