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Appointment Request Form

If this is an emergency, do not contact us via email, please use our emergency contact information.

Prior to the neuro-optometric assessment, a full eye examination is required on a separate day. If a full eye exam has been performed within a year and after the injury, we will require the details of the exam by fax prior to the neuro-optometric assessment. If a full exam was not performed after the injury, a full exam will be required due to possibility of prescription changes and importance of a thorough eye health evaluation.

To request your next appointment, please complete the form below and let us know the most convenient time and date for you. Please don’t forget to include accurate contact details so we can follow up with you to finalize your request.

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
  • :
  • This field is for validation purposes and should be left unchanged.