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Patient History Form

  • Welcome to Petrolia Optometry! Please take a moment to verify and / or update the information below. For privacy reasons, we prefer to not confirm this information out loud in front of others in the waiting area. Thank you!
  • MM slash DD slash YYYY
  • (reachable at a different number than the ones listed above)

  • Guardian Information for Child Patients
  • Petrolia Optometry is pleased to announce that we will be offering a new way to contact you in the near future! Please take a moment to fill out the section below:

  • I have read and understand the above information
  • MM slash DD slash YYYY

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The April 8th solar eclipse is a celestial spectacle not to be missed! But did you know looking directly at the sun, even during an eclipse, can cause permanent eye damage?

Ensure you’re prepared by viewing this helpful resource: Solar Eclipses and Eye Safety (OAO)