Welcome to OHC online intake form
Which location is this regarding? (Not available for Cambridge location)
Are you a ....
Please enter your full name.
Why are you contacting us?
Questions about medication
Questions about surgeries
Book or reschedule an appointment
Please leave a message and we will get back to you as soon as possible (Please indicate patient's name if you are a care provider).
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of ocularhealthcentre.ca.
Terms of Service