Fill out the form before arriving New Patient Information Prefer to print out the form and bring it in? Click here to download the PDF. Name* First Last Email Address* Any personal history of...* Glaucoma Crossed/Lazy Eye Macular Degeneration Retinal Detachment Colour Blindness Blindness Diabetes High Blood Pressure Heart Problems Stroke Thyroid Condition Arthritis Cataracts None Other Any family history of...* Glaucoma Crossed/Lazy Eye Macular Degeneration Retinal Detachment Colour Blindness Blindness Diabetes High Blood Pressure Heart Problems Stroke Thyroid Condition Arthritis Cataracts None Other Personal History - Other: Family History - Other: Medications/supplements*Upload Medication FileAccepted file types: jpg, gif, png, pdf, pages, excel, keynote, Max. file size: 128 MB.Allergies* Occupation/School* Family Doctor* First Last How were you referred to us?*Family DoctorAnother PatientOtherWhat is the primary reason for your visit? Do you wear contact lenses? Yes No I used to wear contacts, but stopped NameThis field is for validation purposes and should be left unchanged.
