Appointment Request Form

Name: Opto-mization NeuroVisual Performance Vision Therapy
Address: 200-775 Topaz Ave, Victoria, BC, V8T 4Z7, CA
Telephone: 250-590-7384
Price range: $000 - $300

Returning Patients: Please click here to book your next visit.

Please fill in the form below to setup an appointment.
Please choose a location for your appointment:*
- Victoria
- Nanaimo
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Reason for Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
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Preferred Date & Times
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Phone*
Email*
Best Time to be Reached for Confirmation*

: Hours

Minutes

AM/PM
Additional Comments?
- Yes
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