top of page


Forms for all new patients

Please Fill out Our New Patient Form

Welcome to the Optometrists Clinic Inc.

In order for our doctors to provide the most appropriate services for your individual eye care needs, we need a little information about your medical history.

Please complete one of the new patient information forms listed on this page and email, or mail it to us, or bring it with you on your initial visit.


Read our privacy policy to learn how Optometrists Clinic Inc protects your information.


Thank you.

Privacy Policy for Optometrists Clinic Inc Centres in the Edmonton Area

Canada has several Privacy Acts which protect patients from unreasonable release of personal information, ensure security of patients' records and guarantee a patient reasonable access to their files. The Optometrists Clinic Inc endorses those Acts, and all employees are obligated to protect patients' privacy.

Personal information collected from patients of this practice shall be limited to that required to:

1. Evaluate Your Health and Vision Status
2. Determine and Recommend Appropriate Treatment or Referral
3. Communicate with You about Services We Provide
4. Provide You with Eye Care, Health or Other Product or Treatment Information
5. Process Payment for Services and Products Received from Our Office
6. Communicate with Others about Your Health and Vision Status

I understand that patient information will only be released to other parties with relevance to my case.

Date _____________________________________________

Patient Signature ___________________________________

The Optometrists Clinic Inc does not sell, give or otherwise distribute personal information to unauthorized parties.

The full Privacy Policy for the Optometrists Clinic Inc is available upon request.

bottom of page