Skip to main content

Eye Care in Ontario is at Risk. TAKE ACTION OAO white logo

Home » Contact Us » Patient Registration Form

Patient Registration Form

Thank you for filling in our forms!

This helps us to limit the time we are talking in the exam lane. We are following provincial and regional health regulations to keep you safe at your eye checkup.

Please remember you will also be required to wear a mask at the clinic.

You will be asked questions about how you are feeling when you arrive.

The Front Door will be locked because we are seeing scheduled appointments only, no drop ins.

If you want to look at glasses too you will need an appointment for that.  All frames you try on are sterilized before being put back on the board and we are limiting the number of people in the frame gallery at any time.  

The doctor will likely be using drops during the exam so bring sunglasses and plan for a driver if you need one. Please complete the information below and submit the form online. 

NO SHOW fees will be charged for any missed appointments.


We need these forms filled in 48 hours before your appointment so the front desk or doctor can prepare for your visit.

This form contains confidential information and is delivered to your doctor through a secure Internet connection.

If you have more to tell us - please send us an email at


Adult Form
Child-Teen Form
Glasses Form
Contact Lens Form
Headache Form