Dr. Michael Lewis


Online Patient Intake Form

Please complete the following form prior to your first appointment.

Patient Information

Please enter your Health Card Number and Version Code. Please enter your full name, as it appears on your Health Card. Please enter your Date of BirthInvalid format. Please enter your family physician. Please select a Driver's License Class. Please select an item. Please select an item.

Vision Insurance

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Patient Allergies

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Patient Medical Conditions

Patient Medications

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Family Medical History

Family Ocular History


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All questions marked with an * must be completed for the submit button to work.


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Patient Portal

View your personal health records online with our secure patient portal, RevolutionPHR.

Map & Directions

745 Gardiners Rd across from the Rio Can and right next door to the Boston Pizza.