Request an Eye Exam Appointment

Use the form below to request an eye exam appointment at any Eye Health Centres location in Calgary or Regina. Please complete all fields. In the comments box at the bottom you may write anything you believe is pertinent to your visit, such as the reason why you are making an appointment.

If you feel your specific request is urgent, please contact us by telephone right away.

About You

Title

Select MrMrsMissMsDr

First Name

Surname

City, Province

Date of birth

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Telephone

Email

Are you a returning patient? Yes No

About Your Appointment

Office Location

Select Location Calgary NW - KensingtonCalgary SW - ShawneeRegina - Lakewood

Preferred Doctor

No PreferenceDr. Diana Monea - Kensington, Shawnee, ReginaDr. Jerome Loewen - ReginaDr. Michelle Vickers - ReginaDr. Tracey Mathew - ReginaDr. Shelly Taneja - Kensington, Shawnee

Appointment 1st choice

Day 12345678910111213141516171819202122232425262728293031 Month FebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberJanuary Year 201220132014 Time Early MorningMid MorningLunch HourEarly AfternoonMid AfternoonLate AfternoonNo Time Preference

Appointment 2nd choice

Day 12345678910111213141516171819202122232425262728293031 Month FebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberJanuary Year 201220132014 Time Early MorningMid MorningLunch HourEarly AfternoonMid AfternoonLate AfternoonNo Time Preference

Appointment type

Select Appt. Reason Regular Eye/Sight ExamContact Lens FittingContact Lens Check/Follow upOther (Provide details in the comment box)

Receive appt. confirmation by: Email, or Phone

Comments

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NOTE: If you are a new patient, after you submit this page you will be asked to print the New Patient Information form, complete it, and bring it with you on the day of your appointment.