top of page

Patient Registration Form
Please fill in the form below.

I am booking appointment at...
Mobile (Cell Phone)?
Mobile (Cell Phone)?

Health Card/Information

(if you don't have OHIP card, please call our office to book an appointment )

healthcard sample.5ed02cf9b24ec4.95724795.jpg
Do you need new eye glasses?
Are you are a contact lens wearer?
I give consent to LivingHope Vision Clinic to contact me regarding my medical reports, my vision/ocular health using the contact information I have provided for personal communication.

Thanks for submitting!One of our staff members will contact you shortly.

bottom of page