Skip to main content

Please note: Ontario optometrists have made the difficult decision to withdraw from delivering OHIP paid exams, due to neglected eyecare funding from the Ontario government for the past 30 years.
Online booking is still available for non-OHIP paid exams, and we are open for retail.
Please call the office to be put on a waiting list if you are an OHIP paid patient. We apologize for any inconvenience.
If you would like to help, please visit saveeyecare.ca or call your MPP.

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!
  • 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