Appointment Request - Royal Oak Optometry - Optometrists in Victoria, BC, Canada

If you are experiencing an Eye Emergency please call our office or see our Eye Emergency Page. Our staff is ready to assist you. All the fields followed by an * are mandatory.

Referred by
Title
First Name*
Last Name*
Phone*
Alternate phone number
Email*
Date of birth*
Date Format: MM slash DD slash YYYY
Are you a contact lens wearer?*
- Yes
- No
Preferred day*
Date Format: MM slash DD slash YYYY

Please note that one of our representative will join you to confirm or to propose a more suitable date.
Hour*
Message/comments
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.