Appointment Request Form

Please fill in the form below to setup an appointment.

Location*

We have 2 locations to serve you better. Our main clinic is still located at 265B Concession Street. Our satellite clinic is located in the east end of Kingston at 677 Innovation Drive, Unit 5, just off Highway 15.

Preferred Doctor*

Title*

Name*

First Last

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Preferred Date & Times*

Please let us know when you would prefer to have your appointment. Our hours are listed to the right.

Appointment Type*

Contact Lens Wearer*

Yes
No

New Patient*

Preferred Method of Contact*

Date of Birth*

Special Considerations*

Special considerations include anything your Optometrist should know ahead of your appointment (eg. poor mobility, interest in contact lenses, English as a second language)

Phone

This field is for validation purposes and should be left unchanged.

Appointment Request Form

St Lawrence Optometry Downtown

St Lawrence Optometry East