Herzig Eye Institute - Send Us a Message/Book Consultation Form

First Name*

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Preferred Provider - Toronto*

Preferred Provider - Ottawa*

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Have you previously had your vision corrected at another clinic?*

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I'd like to stay informed with appointment updates and promotions via SMS, and understand that I can opt out at anytime.*

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By submitting this form, you agree to be contacted by phone, email or text and that any associated call may be recorded for quality and training purposes. The number we will call you from is +1 (647) 873-5855 or +1 (613) 367-5121. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.

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