Skip to main content

Located in Niagara Falls, ON

Book an Eye Exam 844-332-6620
Home » Contact Us » Online Patient Registration Form

Online Patient Registration Form

lock icon Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office. This form contains confidential information and is delivered to your doctor through a secure Internet connection.

x

Enjoy your visit? Please take a moment to leave a review on our Google Business page!