top of page

Medical Questionnaire

COVID-19 is highly infectious and any form of droplets can cause exposure to the virus.  These droplets can contaminate all sorts of surfaces and we have to be vigilant about what we touch to reduce our exposure.  In response, we have developed a more detailed Medical Questionnaire and Consent form.  This new questionnaire will be sent to you prior to your exam and may be a little longer than you are used to. 


The questionnaire includes: 

  • Reason for visit - allows the doctor to prepare ahead of time to better serve you.  This also will allow your doctor to triage whether your exam may be better suited to tele-optometry to better maintain social distancing

  • Current and previous medical and ocular history, medications, allergies - the more information we have before the exam, we can tailor and streamline your visit, limiting your exposure to the doctor, staff and other patients

  • OHIP and insurance information - obtaining this before the exam allows us to verify your eligibility and conveniently bill on your behalf.  

  • Consent - we collect information to better serve you.  We will never release your information without your consent.  This will also allow us to email you a copy of your prescription and invoice for future reference and income tax purposes.

The ultimate goal of this questionnaire is to gain as much information before you arrive to provide a more efficient and safe exam in a way that limits exposure to all.

This form will be emailed to you prior to your exam or you can simply download the file below to email back to us.

bottom of page