To request an appointment, please provide your contact information below and our office will contact you during regular business hours.

If you’d like to save some time during your appointment, you may choose to print and fill out this health questionnaire ahead of time, and bring it with you to your appointment.

Note: For patients aged 19 to 64, MSP does not cover routine eye examinations. If you have an extended health benefits plan (ie. Sunlife, Manulife, Great West Life, Pacific Blue Cross), you may be covered for your eye exam.

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First Name:*

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Last Name:*

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Phone Number:*

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Daytime Phone Number:

Email Address :*

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Contact Me By: Phone Daytime Phone Email

Preferred Appointment Date (MM/DD/YY):*

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Preferred Appointment Time:* Mornings Afternoons Weekends * Required field

Exam Type: Comprehensive Eye Examination Contact Lens Fitting Laser Vision Consultation Other

Notes/Comments:

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