Online Appointment Request Form

Please use the form below to request an appointment time or send us a request for information. We will check our schedules and one of our representatives will contact you to confirm the appointment or to suggest another date and time. All the fields followed by an asterisk (*) are required.

Dr. Lam, Dr. Blanchette, Dr. Macleod, and Dr. Vanderluit are accepting new patients.

All fields marked with an asterisk (*) are required.

Online Appointment form

Personal Information

Title --Please select--Ms.Mrs.Mr.Dr.Rev.

Name *

First Name

last name *

Last Name

Daytime phone *

Email Address *

(Your email address is for confirmation purposes only. It will not be shared with any third party.)

Information for your appointment

Are you a current patient at Visionary Eyecare? *

Yes

No

How did you hear about our office?

Referred by another patient

Internet search/saw our website

Drove by and saw the office building

Yellow pages

Print ad

Online ad

Facebook post

OtherOther

(Thanks for helping us to find out where people are hearing about us!)

Please let us know how old you are:

0 - 19

20 - 64

65 or older

Preferred date:

(Please note: we currently don't offer weekend appointments.)

Preferred time: --Please select one--AnytimeEarliest availableLatest available8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm (Thursdays only)12:30 pm (Thursdays only)1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm (Thursdays only)5:30 pm (Thursdays only)6:00 pm (Thursdays only)

Preferred optometrist: * --Please select--No preferenceFirst availableDr. Louis BlanchetteDr. Kirby LamDr. Elena MacleodDr. Kristen Vanderluit

Anything else we should know?

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