Suite 205, 1466 Bathurst Street  Toronto, M5R3S3.
416.516.EYES (3937)

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Your Contact Information

First Visit ? Yes    No
Title:
First Name:  
Last Name:
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Email:
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Preferred Appointment Times

Appointment Preference #1:

Date: Time:

Appointment Preference #2:

Date: Time:

Other Comments:

Please Note: The times you have chosen are your preferred times and may or may not be your actual appointment time. We will definitely try to schedule your appointment in your #1 time slot preference, but if we are unable to do so, then we will proceed by scheduling you in your 2nd preferred time slot. Your appointment time is not official until you have received confirmation from us.