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

If you would like schedule an eye exam, you can either phone our office (250) 479-8206 or fill out the form below. 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.