Skip to main content
Home » Contact Us » Patient Intake Forms » Medical Records Release Form

Medical Records Release Form

Request and Release of Medical Records

To Whom it May Concern

Please release the medical records of the following patient to St Lawrence Optometry via fax to 613-549-4510 or email to - Patient Name:
MM slash DD slash YYYY
Previous Optometrist/Ophthalmologist:

SLOpt logo horiz col

For those of you who have received notice of your 80+ driving assessment:

You are welcome to book an appointment with our office to complete the vision assessment, however, we wanted to inform you that OHIP does not cover any service related to the continuation of a driver's license, including the eye exam and the report. Alternatively, you may visit a DriveTest location to obtain the required vision tests at no charge to you.