Kindly fill the form below to book the appointment now.
Or you can print this form, fill it and bring it during your visit.

Clarity Eye Institute

Welcome to Clarity Eye. This form must be completed and signed before you may receive care in our clinic. No information contained in your medical record will be sold to a third party for any purposes. Every effort will be made to see patients in a timely order. We thank you for your patience.

Please Hand In Your Healthcard With This Form

  • or
  • Workers Compensation Claim. Please complete if injury is work related.

Disclaimer

Ophthalmologists accept new patients by medical referral only. Please ensure your doctor has forwarded the referral prior to contacting the office to assist with scheduling appointments at Clarity.

Working with the surgery team for the updated patient resources that we have on our current website so they too can be printed or filled on line and submitted to clarityeye.surgery@gmail.com