Referrals & Forms

We accept referrals for vision therapy from health care providers, prospective and current patients, parents, educators, as well as family & friends.  We are happy to answer any questions if you feel vision therapy may be right for you or someone you know.

Referrals from Health Care Professionals

Many different health care providers refer patients for vision therapy and rehabilitation services, such as family doctors, physiotherapists, occupational therapists, optometrists and chiropractors.  To refer a patient, please complete the form below and fax to the clinic at (905) 875-5468.

Click to access our:  Referral from Health Care Provider Form

Referrals from Non-Health Care Professionals

Please call or email the clinic directly and we will answer any questions you have and send you information about the assessment process.

Phone: (905) 876-6042


Appointment Forms

Please see below for our appointment forms.  The appropriate form can be filled out and returned to the office prior to your appointment.  If you have any questions, please call or email the clinic at (905) 876-6042 or

Click to access our:

Medical History and Needs Form

COVID-19 New Office Protocols

Proudly serving Milton, Georgetown, Acton, Oakville, Mississauga, Burlington & surrounding areas