Are you a physician referring a patient for an oculo-visual examination?


Please use the fillable PDF file below. You may email the completed form to or fax it to us at (416) 583-5826.


Our optometrists can often accommodate for same day or next day appointments and would be happy to send you back a report.

Please note, this service is intended for individuals who are at risk of ocular disease due to a confirmed systemic condition or who have an ocular health abnormality. This does not cover refractions (ie. prescription updates for glasses or contact lenses).

Routine eye exams or exams for minor issues are not covered by OHIP, and those individuals are encouraged to use our New Patient Exam Request Form instead.