request an appointment

Thank you for contacting us. To help us book you an appointment please fill out the form below or if you are a new patient click here:

New Patient

appointment Contact form

Please fill out the form below with your name, date of birth, email address and either your cell phone (preferred) or alternate number. Thank you and we look forward to seeing you.

Are you a new patient ? (Yes or No)*

Full Name*

Date of Birth*

Health Card Number (including two last letters)

Preferred appointment slot (morning or afternoons and day of the week)

Email*

Cell Phone

Phone (alternate)

Preferred method of contact? (Email or Phone)*

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NEW PATIENT CONTACT FORM

Welcome and thank you for contacting us. Please fill out this new patient contact form which will help us in booking you an appointment and determine if you are covered under OHIP.

Are you currently on ODSP (Disability) or Ontario Works ? (Yes or No)*

Are you 65 or older or 19 and under ? (Yes or No)*

Do you have Diabetes, or an eye disease such as glaucoma, cataracts, macular degeneration, an eye turn or a lazy eye? (specify) *