The Eye Studio - Optometry In Red Deer County, Alberta Canada

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403-352-8846

Home New Patient Center Online FormsWelcome to The Eye Studio

Patient Information

First Name: *

Last Name: *

Date of Birth: (DD/MMM/YYYY) *

Primary Phone: *

Email Address:

Address:

Gender:

Occupation:

Insurance Infomration

The Eye Studio offers the convenience of Direct Billing to a number of insurance companies.

Insurance Company:

Group or Policy Number:

Plan or ID Number:

Subscriber Last Name:

Subscriber First Name:

Patient History

Please bring with you to your appointment a list of current medications and allergies.

What is the major purpose of this visit? (Please include additional information that we should know prior to your appointment. Example: Disabilities or Medical Conditions)

When was your last Eye Examination?

Where was your last Eye Examination?

Lifestyle Questions

To help us provide you with the best vision, select any of the following activities that apply to your lifestyle in work or pleasure:

How much time per day do you spend on Digital Devices? (Computers, Smart Phones and or Tablets)

Lifestyle Activites

Outdoor / Indoor Sports

Water Sports

Flying

Desk Work

Reading

Do you.... (Check if your answer is yes)

Want anything improved with your current glasses?

Work at a computer?

Regularly spend time outdoors?

Prefer not to wear glasses at times?

Want information on Laser Vision Correction surgery?

Have family member in need of eyecare?

Contact Lens Wearers

Have you had any eye surgeries?

If yes, what kind and when?

Do you wear contacts?

How many days a week are you wearing contacts?

What kind of contacts are you wearing?

Is there anything you would like improved with your current contacts? (Example: comfort, dryness, multifocal)

Exclusive Offer

Request an Appointment

Office Hours

Day	Morning	Afternoon
Monday	8:00am	6:00pm
Tuesday	11:00am	8:00pm
Wednesday	8:00am	6:00pm
Thursday	8:00am	6:00pm
Friday	8:00am	4:30pm
Saturday	Closed	Closed
Sunday	Closed	Closed

Day	Morning	Afternoon
Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
8:00am	11:00am	8:00am	8:00am	8:00am	Closed	Closed
6:00pm	8:00pm	6:00pm	6:00pm	4:30pm	Closed	Closed

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104 488 McCoy Drive Red Deer County, Alberta T4E 0A4
403-352-8846