Appointment Form

First Name*

Last Name*

Email*

Phone number*

(###) ### ####

Are you a contact lens wearer?*

Yes
No

Preferred Doctor

Can we phone you to book this appointment?

Preferred Day - check any that apply

Preferred Time*

Will you be looking for new glasses at this appointment?*

If you want to choose new glasses, the same day as your exam, please let us know, now - as we need to book an appointment with our Optical Staff the same time as we book your exam with your doctor. Thank you.

Referred by

Message / Comments*

I am a*

If you are a NEW PATIENT, please complete the additional field below, thank you.

Address*

Please include full mailing address, including PO Box numbers and postal code.

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Phone

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

Contact Info

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Monday:	7:45am to 5pm
Tuesday:	7:45am to 5pm
Wednesday:	7:45am to 5pm
Thursday:	7:45am to 6pm (closed 11:45-1:00 pm)
Friday:	7:45am to 5pm
Saturday:	7:45am-12 pm (September to May)
Sunday:	Closed