Book Eye Exam

Use our convenient online form to book an Eye Exam with Glasses To Go, Mobile Vision Care, and choose from the payment options below:

Please mail forms to Glasses To Go with payment to:

Glasses To Go
93 Courtenay Terrace
Sherwood Park, AB T8A 5S6

Or e-transfer funds to glasses2go@shaw.ca

Patient's Name

First Name

Last Name

Patient's Address

Address of where the Patient resides (a Private Residence, Care Centre, or Hospital). *If the Patient is currently living in a Care Centre or Hospital, please indicate on address line 2 which unit/floor/room they are located.

Address

City

State/Province

Zip/Postal

Phone Number

Phone number of Patients residence or room, unit, nursing station, etc.

Phone

Name of Family Contact/Guardian/Public Trustee

First Name

Last Name

Phone

Does the Family Contact, Guardian or Public Trustee want to attend the eye exam visit?

Yes

Authorization to release medical records including past eye exams to our Optometrist

Type Patient's name or the name of the family contact, guardian or trustee

Comments regarding any Patient health concerns, medications or conditions that the doctor should be aware of prior to the appointment

Address that the Eye Exam Receipt should be mailed to if other than the Patient's address (eg. the office of the Public Trustee)

Address

City

State/Province

Zip/Postal

Terms of On Site Eye Exam & Service

On site call fee: Includes 2 visits for fitting and adjustments of a complete pair of eye glasses within the first year.

Eye exam policy: 30 days from time of assessment for recheck and lab redo, if required. Frame only is a final sale with no warranty and no exchanges.

Complete order placed but not processed within 30 days of issues receipt are considered final sale with no exchanges or refunds.

Orders cancelled or changes to original order are subject to a restocking fee of 25% and require original receipts to be changed or cancelled. If there is no receipt it is considered a final sale.

Warranty is limited to manufacture defects only. Warranty is of frame and lenses are glued, soldered, have dog teeth marks or any other abuse is done to the original frame or lenses.

Fee Schedule - Please contact our office by phone if you want information regarding our fees. We accept payment by etransfer for our onsite call fee for the eye exam.

Book Eye Exam

Book Eye Exam

Use our convenient online form to book an Eye Exam with Glasses To Go, Mobile Vision Care, and choose from the payment options below:

Please mail forms to Glasses To Go with payment to:

Glasses To Go
93 Courtenay Terrace
Sherwood Park, AB T8A 5S6

Or e-transfer funds to glasses2go@shaw.ca

Patient's Name

Patient's Address

Phone Number

Name of Family Contact/Guardian/Public Trustee

Authorization to release medical records including past eye exams to our Optometrist

Address that the Eye Exam Receipt should be mailed to if other than the Patient's address (eg. the office of the Public Trustee)

Terms of On Site Eye Exam & Service

Fee Schedule - Please contact our office by phone if you want information regarding our fees. We accept payment by etransfer for our onsite call fee for the eye exam.

IN-HOME. NURSING HOME, ONSITE
OR OFFICE EYEWEAR CONSULTATION

Menu

Contacts

Have Any Questions?

Mobile

Mail Us

2024 © Copyright GlassesToGo. All rights Reserved. Powered by ClickIt Social Inc.

Book Eye Exam

Use our convenient online form to book an Eye Exam with Glasses To Go, Mobile Vision Care, and choose from the payment options below:

Please mail forms to Glasses To Go with payment to: Glasses To Go 93 Courtenay Terrace Sherwood Park, AB T8A 5S6 Or e-transfer funds to glasses2go@shaw.ca

Patient's Name

Patient's Address

Phone Number

Name of Family Contact/Guardian/Public Trustee

Authorization to release medical records including past eye exams to our Optometrist

Address that the Eye Exam Receipt should be mailed to if other than the Patient's address (eg. the office of the Public Trustee)

Terms of On Site Eye Exam & Service

Fee Schedule - Please contact our office by phone if you want information regarding our fees. We accept payment by etransfer for our onsite call fee for the eye exam.

IN-HOME. NURSING HOME, ONSITE OR OFFICE EYEWEAR CONSULTATION

Menu

Contacts

Have Any Questions?

Mobile

Mail Us

2024 © Copyright GlassesToGo. All rights Reserved. Powered by ClickIt Social Inc.

BOOK YOUR EYE EXAM

Please mail forms to Glasses To Go with payment to:

Glasses To Go
93 Courtenay Terrace
Sherwood Park, AB T8A 5S6

Or e-transfer funds to glasses2go@shaw.ca

IN-HOME. NURSING HOME, ONSITE
OR OFFICE EYEWEAR CONSULTATION