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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:

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.

Due to the current state of the pandemic, we are conducting enhanced screening to minimize the risk to our patients and staff. We appreciate your patience and understanding.

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