Appointment Request Form

Monday: 8:00 AM - 4:00 PM
Tuesday: 8:00 AM - 6:00 PM
Wednesday: 8:00 AM - 4:00 PM
Thursday: 8:00 AM - 4:00 PM
Friday: 8:00 AM - 2:00 PM
Saturday: Closed
Sunday: Closed

Name: Main Office Location
Address: 85 The East Mall, Suite 102, Etobicoke, ON, M8Z 5W4, CA
Price range: $000 - $300

If this is an emergency, do not contact us via email, please use our emergency contact information.

Patient Forms:

Complete the following form to request an appointment:

Please fill in the form below to setup an appointment.
Reason for Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Phone*
Email*
Best Time to be Reached for Confirmation*

: Hours

Minutes
I currently wear*
- Glasses
- Contact Lenses
- None of the above
Comments
Include details about contact lenses/glasses if applicable
Comments
This field is for validation purposes and should be left unchanged.

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