Request an Appointment

Your date of birth: *

Your cellphone number:

Your email: *

Your complete address: *

Your daytime phone number: *

Which doctor would you like to see? *

Dr. Popick

Dr. Caines

No Preference

Health card number (new patients only):

How would you like us to contact you? *

Email

Daytime phone

Cellphone (if provided above)

Your name: *

What is the purpose of your visit? *

Routine eye examination

Contact lens inquiry

Refractive laser surgery inquiry

Red eye

Other (please indicate other reason below)

Please indicate purpose of visit if you chose Other above:

What is your preferred time of day? *

Morning

Afternoon

No preference