Dr. Michael Lewis

613-507-0707

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

Referrals

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

Appointments

Book an appointment today to have your eyes examined by our team of professionals.

Shop Online

Shop online for all your eyewear needs in the comfort of your own home.

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.