Home » Contact Us » Appointment Request Form

Appointment Request Form

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
  • :
  • Canadian Anti-Spam Legislation

    As per the Canadian Anti-Spam Legislation, I am providing my Express Consent to communicate electronically. I understand that my consent may be withdrawn at any time by emailing theeyedoc.ca@gmail.com
  • This field is for validation purposes and should be left unchanged.