Book a Consultation

The fields marked* are required to be entered.

• Your Full Name:
• Date of Birth: (day/month/year)
• Address:
• City/Town:
• Postal Code:
• Phone (Daytime):
• Phone (Evening):
• Mobile Phone:
• Note: Please include area code in phone numbers
• Email:
• Reason for Consultation
• I would like to be contacted regarding booking a consultation with the ophthalmologist. I understand that this is a comprehensive medical examination of my eyes by the specialist, the cost of which is $170