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.

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Pronouns
Inclusivity is essential for well-being and a sense of belonging, and we are taking steps to ensure that all communication with our community members is reflective of those values.
First Name*
Last Name*
Phone*
Alternate phone number
Email*
Date of birth*
MM slash DD slash YYYY
Are you a contact lens wearer?*
- Yes
- No
Preferred day*
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
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Name
This field is for validation purposes and should be left unchanged.