Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office.

This form contains confidential information and is delivered to your doctor through a secure Internet connection.

We offer multiple ways to book an appointment at our Kelowna eye clinic. Whether you’re a new patient or coming back for follow-up care, choose the option that works best for you below, and we’ll guide you through the rest. Please note that booking isn’t confirmed until you speak with our team member or receive a confirmation email.

This is the fastest way to book us—through our real-time patient portal. Here you can view availability, manage your appointments, and securely update your details.

Call/Text us, ask questions, we’d love to hear from you! Just give us a call, or you can text us anytime during business hours and our team will walk you through your options and answer any questions you have.

Our Appointment Request Form emails us direct to our team—and we are checking it regularly. Just share a few details about your needs, and one of our staff members will reach out to assist you.

Patient Registration Form

Patient Information

Personal Information

Eye History

Medical History

Eyewear History

Primary Insurance

Secondary Insurance

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Vision Therapy Screener

Location Check

High Risk Indicated

Want to help your visual system at home?

Vision Therapy Screener

Location Check

High Risk Indicated