Appointment Request Form

Please fill in the form below to request an appointment. You will receive an e-mail from our office shortly with our first available appointment time.

Reason for Appointment

Please provide a reason for your appointment. Details are stored securely and not sent by email.

Preferred Date & Times*

Full exam appointment availability from 9 am to 3 pm. Please Note: As of January 2023, we are currently booking regular eye exams 4-6 weeks in advance! Our hours of operation are listed on our location page.

Patient Type*

New patient
Returning patient

Provider*

Adjustments/Glasses
Dr. Tannis Shakya

Name*

First Last

Date of Birth*

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

Email*

Comments

Please let us know if you have any further questions regarding your appointment.

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Email

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Spectrum Eyecare and Eyewear