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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:

We remind you to check the expiry date of your health card prior to your appointment. ALL RED & WHITE health cards without expiry dates will no longer be valid as of September 30th, 2022. If your health card is expired you will be required to pay out of pocket for your health services.