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Patient Intake Forms

Please select one of the following forms that is best suited for you.

Printable PDF Form

You can print the following form, complete it at home, and bring it with you to your appointment.

Online Form

You can submit the following form completely online. No need to print!

Please be aware that if you normally have OHIP coverage, ODSP coverage or OW coverage for your eye exams, we are unable to schedule an appointment for you at this time due to the current Ontario Association of Optometrists job action. You can help by visiting which will let the Government of Ontario know that eye care is important to you and your family.

Our hours of operation have changed as we are currently seeing patients by appointment only for ALL visits (including glasses adjustments, etc). Please contact our office to book an appointment as needed.

We are continuing to follow health and safety guidelines as set out by the College of Optometrists of Ontario and the Government of Ontario.


Our office protocols have changed considerably due to the COVID-19 pandemic. Please refer to our COVID-19 Building Entry Policy