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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!


In compliance with the Ministry of Health, the Ontario Association of Optometrists, and the College of Optometrists of Ontario we are temporarily closed for routine exams until further notice in an effort to protect our patients, staff, and community members from the spread of the COVID-19 virus.

If you should experience an ocular emergency or have concerns about your eye health during this time please call 613-546-5744 or email Our admin assistant will be available Monday to Friday from 9:00 am to 12:00 pm.

Please refer to our COVID-19 Building Entry Policy