Warning: mysql_real_escape_string(): Access denied for user 'optometry'@'localhost' (using password: NO) in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms-database.php on line 145

Warning: mysql_real_escape_string(): A link to the server could not be established in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms-database.php on line 145

Warning: Attempt to assign property of non-object in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms-baseclass.php on line 659

Warning: Missing argument 2 for wpdb::prepare(), called in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms.install.php on line 380 and defined in /home/optometry/public_html/wp-includes/wp-db.php on line 1247

Warning: Missing argument 2 for wpdb::prepare(), called in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms.install.php on line 1007 and defined in /home/optometry/public_html/wp-includes/wp-db.php on line 1247

Warning: Missing argument 2 for wpdb::prepare(), called in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms.install.php on line 1048 and defined in /home/optometry/public_html/wp-includes/wp-db.php on line 1247

Warning: Missing argument 2 for wpdb::prepare(), called in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms.install.php on line 1070 and defined in /home/optometry/public_html/wp-includes/wp-db.php on line 1247

Warning: Missing argument 2 for wpdb::prepare(), called in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms.install.php on line 1202 and defined in /home/optometry/public_html/wp-includes/wp-db.php on line 1247

Warning: Missing argument 2 for wpdb::prepare(), called in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms.install.php on line 1235 and defined in /home/optometry/public_html/wp-includes/wp-db.php on line 1247

Warning: Missing argument 2 for wpdb::prepare(), called in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms.install.php on line 1289 and defined in /home/optometry/public_html/wp-includes/wp-db.php on line 1247

Warning: Attempt to assign property of non-object in /home/optometry/public_html/wp-content/plugins/easy-contact-forms/easy-contact-forms-baseclass.php on line 659
BOOK AN APPOINTMENT « optometryonhydepark.com

EMERGENCY OR
URGENT BOOKINGS
Please call 519.473.2333 to
book your appointment.

UNABLE TO MAKE
YOUR APPOINTMENT?
To change your booking,
please provide 24 hours
advance notice.

A charge may apply to same day cancellations.

Book an appointment

Please use the form below to book your appointment and a staff member will contact you within 24 hours to confirm the details of your booking. 

If you prefer, you can also contact us by phone at 519.473.2333.

What is the reason for your appointment?
 Routine
 Partial Examination (address a particular concern or a follow-up exam)
 Contact Lens Fitting
 Contact Lens Progress Check (for current contact lens patients)
 Other:

Are you a new or existing patient?
 New Patient Exisiting Patient

Do you wear contact lenses?
 Yes No

Patient Information:
First name: (required)

Last name: (required)

Date of Birth (mm/dd/yyyy): (required)

Phone number: (required)

Alternative phone number: (required)

Your Email: (required)

Your name: (if booking for someone else):

Your relationship to Patient:

Your preferred day of the week? (check all that apply):
 Monday Tuesday Wednesday Thursday Friday Saturday

Your preferred time of day? (check all that apply):
 9AM-11AM 11AM-2PM 2PM-5PM after 5PM

Do you have any comments or questions for us?