Please fill out all information below.To see where to find your health card number click here
If no information is available please enter NA.
Please provide as much detail for each question. If no information is available please enter NA.
Please take close up pictures of both eyes with the flash ON. For instructions on taking the pictures click here.
To assist us with your e-assessment, we recommend you do a quick online vision test HERE and when complete enter your numbers below.
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