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Request An Appointment

Please take a moment to fill out the form below. This form is for existing patients and patients that are interested in Laser Vision Correction. The doctors and staff of NTEC look forward to answering any questions or addressing any concerns you may have. Please note that we cannot guarantee that your request date and time will be available. One of our staff members will contact you to arrange the appointment.

Note: Do not use this form in case of an emergency!

Personal Information

First Name *
Home Phone *
E-Mail *
First Preferable Date
Second Preferable Date
Are You a New Patient?
Yes No
Last Name *
Cell Phone
Date of Birth
Time of Day: Morning/ Afternoon/ Evening
Time of Day: Morning/ Afternoon/ Evening
Your Eye Doctor's Name:

Additional Questions

How did you hear about our practice? (Please select one)
How did you find our website?
Do you have an eye doctor?
Check items that you are inquiring about, or type your question in the text box below:
Freedom from glasses
Botox/Fillers
LASIK
Cosmetic Latisse
Cataract Surgery
Appointment Change
Appointment Cancellation
I need an appointment (Existing Patient)
Dry Eye Consultation
Cross-Linking/Intacs
Please Type any other questions here:

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Please be aware that this is a non-secure communication.

 

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Tel: 416-748-2020
 
Toll Free: 1-888-748-2021


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