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As per provincial recommendations, this office being a health care facility, continues to require masks. We also have appointments for all services, frame selections, adjustments and repairs. Thank you.

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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.

We need these forms filled in at least 24 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 reception@boltonoptometry.ca

Adult Form
Child-Teen Form