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Patient Forms

Forms 1

If you are interested in booking an assessment, please fill out the appropriate intake form and send it to our office.

If you are an Optometrist and would like to refer a patient, please fill out the ‘Refer a Patient-Optometrist’ form.

If you are a health care professional (Family Doctor, Physiotherapist, Chiropractor, Occupational therapist etc.) and would like to refer a patient, please fill out the ‘Refer a Patient-Professional’ form.

If you are an education professional (teacher, tutor or parent )who would like to refer a student for a visual skills assessment, please fill out the ‘Refer a Patient-LRVP’ form.

If your child is having trouble at school, have the teacher fill out this checklist. It’s a great way to inform the teacher of the visual difficulties your child may be having, and get their feedback (signs and symptoms are most likely to show up in the classroom).