Appointment Request Form

Name: Bolton Optometry Clinic
Address: 12 Parr Blvd, Unit 12, Bolton, ON, L7E 4H1, CA
Telephone: 905-857-2020

**Please note: eye drops will be administered during your exam.

Book A General Eye Care Appointment

Vision Therapy or Neuro-Optometric Rehabilitation or Myopia Control Appointment

If you would like to book a Vision Therapy or Neuro-Optometric Rehabilitation appointment, or Myopia Control appointment, please fill out the form below.

Specialty Appointment Type*
Please select the type of appointment you are requesting. If you are interested in booking a general eye care appointment, please click HERE
Reason for Appointment
Preferred Date and Times
Patient Type*
- New patient
- Returning patient
Name*
First Last
Phone*
Email*
Best Time to be Reached for Confirmation

: Hours

Minutes

AM/PM
Comments
Name
This field is for validation purposes and should be left unchanged.

**Please note: eye drops will be administered during your exam.

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