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Make an Appointment for a Comprehensive Eye Examination

Click Here for more details on your eye examination
You are welcome to use this form to make an appointment for an eye examination however while we will try to accommodate your preferences, please be aware that this is not always possible.  This form is a REQUEST for appointment only and we will phone or email you to confirm your appointment within 24 hours of receiving your enquiry (unless your request is made over the weekend or on a public holiday).
If your request is URGENT or your eye condition requires immediate attention, please do not use this form but TELEPHONE US DIRECT ON 03 366 6249.

All details provided are confidential and will only be used by Curtis Vision for the purposes they are intended.
Fields marked with * are required

Your Details

First Name *
Surname *
Phone Number *
Email *
Have you been under the care of Curtis Vision before? *

 


 

Appointment Details

Patients Name *
Patients Date of Birth *
Reason For Appointment *
Preferred Date
Please select a location you would prefer
Preferred Time *

 


 

Additional Information

Please supply any other information which may be relevant to your appointment
 


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