Request an appointment

 

This form enables you to request an appointment with one of our optometrists at our Canal Walk Branch. The appointment is only confirmed once we have contacted you. All appointments must be made 48 hours in advance from Monday to Friday and 72 hours in Advance Saturday and Sunday

 

Optometrist Select Optomitrist Winston Davies Johan Coetsee Leandri Venter

Optometrist :: Please esnure correct Optometrist is selected

 

Please note that Leandri Venter is only available on Monday and Tuesday

 

Appointment Date

 

Time

Time :: Please use the format time H:MM then am or pm

 

Date

 

Alternate Date

 

Time

Time :: Please use the format time H:MM then am or pm

 

Date

 

Your Information

 

Name

Name :: Please Enter your Name

 

Contact Number

Contact Number :: Please enter your Telephone or mobile number in order for us to contatc you

 

Email Address

Email Address :: Please enter your email address

 

Additional Information

 

Enter Code   

Enter Code :: Please type it exactly with upper and lower letters as displayed