Get Canada Uptown Eye Specialists Consultation Request Form 2022-2025

This guide provides clear, step-by-step instructions on how to fill out the Canada Uptown Eye Specialists Consultation Request Form online. By following these instructions, you will ensure a smooth and efficient process for your consultation request.

Follow the steps to complete your consultation request form online:

1. Click the ‘Get Form’ button to access the consultation request form and open it in your preferred editor.
2. In the first section, enter the referring doctor's name and their OHIP billing number.
3. Fill in your email address, office phone number, and fax number in the respective fields.
4. Provide your last name, choose your gender by marking the appropriate box, and enter your health card number along with the version code.
5. Enter your given name and date of birth in the specified format (Year-Month-Day).
6. Complete your full address, email address, mobile phone number, home phone number, and any alternate contact details.
7. Choose your preferred reminder method from email, SMS text, or voice call.
8. Select your preferred consulting doctor from the list provided, or opt for 'No preference'.
9. Indicate the location where you would like the consultation to take place, whether it is any site, Brampton, Vaughan, or Scarborough.
10. Select the urgency of your appointment by checking the appropriate box.
11. Specify the reason for your referral by checking or circling the relevant options from the list provided.
12. If applicable, indicate additional eye conditions or treatments related to your referral.
13. Lastly, add any additional information or remarks in the provided section.
14. Once you have completed all sections, you can save your changes, download the form, print it out, or share it as needed.

Please complete your consultation request form online to schedule your appointment.