Skip to main content

 

Our Location

4137 Petrolia Line
Petrolia, ON N0N 1R0

Book an Exam 226-778-2166 COVID-19 Updates
Child-page-Images
Home » Contact Us » Patient History Form

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!
  • Date Format: 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
  • Date Format: MM slash DD slash YYYY
x

We are open for general eyecare! Our hours – Monday – Friday, 8:30 to 5. When shopping for glasses, you will enjoy the attention of a Personal Shopper as one of our enhanced hygienic measures! Please click here to read our new hygiene protocol.

An important notice from Dr. St. Pierre: Today, optometrists in Ontario start Job Action. Ever ytime a patient walks through my door for an exam, it costs me on average $80 (staff, PPE, office supplies, occupation costs) to see that person. That’s before I get paid for my time. The Ontario government pays me $25.15 to perform a partial exam and does not allow me to bill the patient any more. That means every time I see a patient for an OHIP covered eye exam, I am subsidizing the cost of that eye exam out of my own pocket. This is not sustainable. As a small business owner in the time of COVID-19, I am struggling to provide quality eyecare to my community with the current OHIP funding agreement. As of today, all patient driven partial exams and MEE exams will no longer be booked in my clinic, but referred elsewhere. Thank you for your understanding.