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

Please see our latest news post on Coronavirus (COVID-19) for more information. As of March 19, 2020, we are not scheduling routine eye exams due to this ongoing crisis until it is safe to do so. If you would like to fill out this form we will let you know when we resume scheduling resume eye exams. 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
Name
This field is for validation purposes and should be left unchanged.