Killarney Optometric Centre
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Request Vision Exam
First Name
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Last Name
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Date of Birth
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New Patients only:
MHSC #
MHSC PHIN #
Daytime Phone Number
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Cell Phone Number
Email Address
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I would like to schedule a vision exam with:
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Dr. Candace DeCock (No Mondays)
Dr. Dustin McGill
No Preference
Information regarding your vision examination:
Please arrive a few minutes before your appointment time
If you wear contact lenses, please wear them to your appointment & bring your glasses
Bring a list of any medications you are taking
Bring all 3rd party insurance numbers
Please indicate any specific questions or concerns briefly below:
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Services List
Eye Examinations
Frame Dispensing Lens Consultation
Contact Lens Fittings
O.C.T. Scans
Low Vision Aids
Visual Perceptual Therapy
Cataract Assessment
Glasses Repair
Glaucoma Assessment
Pachymetry
Refractive Surgery Consultation & Assessment
Retinal Photography
Tonometry
Vision Therapy
Visual Field Analysis
Get Your Eyes Checked
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