Referrals

Patient Referral Form

Referral

If you are an eye care professional (optician, optometrist, ophthalmologist), please use this PDF form to refer your patient for Low Vision care.

Please Click HERE to download the PDF form and submit the form via fax to:
613-228-8635













Professional
Eye Conditions

 

Hand Held Devices
Hands Free Systems
Telescopes & Binoculars
Video Magnifiers
Non-optical Aids