SCHEDULE AN EYE EXAM

SCHEDULE

FOR YOU AND YOUR FAMILY
Location *
Who Is This Exam For?
Note: Please enter the name as appeared in your Health Card
Firstname *
Lastname *
Address
Health Card Number *
Version code *
Sex *
Male Female
Date of Birth *
My Email *
Family Physician
Exam Information
Has this patient had an eye exam with us at this location?**
Yes
No
Does this patient require a contact lens fitting?**
Yes
No
Please select a preferred date and time * *
10:00 AM, Dr.Sukanthy Bream
11:00 AM, Dr.Sukanthy Bream
11:30 AM, Dr.Sukanthy Bream
12:00 PM, Dr.Sukanthy Bream
12:30 PM, Dr.Sukanthy Bream
1:00 PM, Dr.Sukanthy Bream
1:30 PM, Dr.Sukanthy Bream
2:00 PM, Dr.Sukanthy Bream
2:30 PM, Dr.Sukanthy Bream
3:00 PM, Dr.Sukanthy Bream
3:30 PM, Dr.Sukanthy Bream
4:00 PM, Dr.Sukanthy Bream
4:30 PM, Dr.Sukanthy Bream
5:00 PM, Dr.Sukanthy Bream
5:30 PM, Dr.Sukanthy Bream
6:00 PM, Dr.Sukanthy Bream
6:30 PM, Dr.Sukanthy Bream
7:00 PM, Dr.Sukanthy Bream
Contact Info
Primary Phone *
Secondary Phone *
I certify that I am 18 years or older. *
Yes, I would like to receive eye appointment reminders via text message *
I agree with the The Optometry Practice SMS Terms & Conditions below.* *
**Please kindly bring your Health card along with your eye glasses (including sunglasses) when you come to see the doctor.