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Located in the Mill Woods Town Centre Professional Building

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About Us
- Hours & Location
- Our Eye Doctors
Vision Therapy
Myopia Management
Dry Eye
Scleral Lenses
Eye Care Services
Eyeglasses
Contact Lenses
Insurance

Home » Contact Us » Appointment Request Form

Appointment Request Form

Please fill in the form below to setup an appointment.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
This exam is for:
- A Child
- An Adult
Latest in Child Eye Care
Is your child's vision getting worse? If your child is myopic, showing signs of progression, or is at risk of myopia progression, Our eye doctor will discuss myopia management at your child upcoming eye exam. Feel free to contact us at 780 666 3254 before your eye exam to learn more about this service or browse our website for further resources.
Reason for Appointment*
- Child is getting more nearsighted each year. Learn More Here
- Myopia Management or Control
- Ortho-K or CRT or GVSS (Vision Correction)
- Vision Therapy (Eye Therapy)
- Reading & Learning Problems in Children
- Lazy Eye (Amblyopia) or an Eye Turn (Strabismus)
- Child with Special Needs
- Attention or Concentration Problems
- Regular Eye Exam
- Contact Lens Exam
- Other
Choose from any of the following options.
Reason for Appointment*
- Tearing or watery eyes
- Sensitive or rubbing eyes
- High Astigmatism or High Prescription
- Keratoconus or Irregular Cornea
- Poor vision wearing contacts or glasses.
- Safe alternative to LASIK w/o surgery
- Ortho-K (Vision Correction)
- Eye Conditions and Diseases
- Headaches & Migraines
- Dizziness, Vertigo, Poor Balance
- Attention or Concentration Problems
- Post concussion, head trauma, stroke or brain injury
- Improve Visual Abilities for Athletes
- Vision Therapy for Adults
- Regular Eye Exam
- Contact Lens Exam
- Other
Please Specify*
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Name*
First Last
Phone*
Email*
How did you find us?*
Please Specify*
Comments
Comments
This field is for validation purposes and should be left unchanged.

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Patient History Form

Lifetime Eyecare

6203 28 Ave NW
Edmonton, AB T6L 6K3

Phone: 780-462-7500
Email: info@lifetime-eyecare.ca
(Do not send personal health information by email.)

Monday: 9:00 AM - 5:00 PM
Tuesday: 12:00 PM - 8:00 PM
Wednesday: 12:00 PM - 8:00 PM
Thursday: 9:00 AM - 5:00 PM
Friday: 9:00 AM - 5:00 PM
Saturday: Closed
Sunday: Closed

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Lifetime Eyecare
6203 28 Ave NW
Edmonton, AB T6L 6K3
Phone: 780-462-7500
https://www.lifetime-eyecare.ca

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