Referrals

Name: Yonge Eyes Optometry
Address: 3220 Yonge St. 2nd floor, Toronto, ON, M4N 2L2, CA
Telephone: (416) 901-9771
Price range: $000 - $300

Optometrist or Ophthalmologist

Patient Name*
First Last
DOB
Date Format: MM slash DD slash YYYY
Phone
Alternate Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reason For Referral
- Vision Related Learning Difficulty
- Binocular Coordination/Accommodative Dysfunction
- Strabismus or Amblyopia
- Concussion/Acquired Brain Injury
Pertinent History
Medications
Refraction OD
Acuity OD (20/)
Refraction OS
Acuity OS (20/)
Binocular Vision Test Results
Ocular Health
Comments
Referring Optometrist or Ophthalmologist
Referring Clinic

Allied Professional

Patient Name*
First Last
DOB
Date Format: MM slash DD slash YYYY
Phone
Alternate Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Pertinent History
Medications
Comments
Referring Professional
Referring Clinic, School, or Organization

Attention Patients:

As mandated by the College of Optometrists of Ontario to protect our patients, doctors, and staff from COVID-19 exposure, Yonge Eyes Optometry will be closed from March 18 until further notice. You may book online during this time.

We will keep you posted as this timeline is subject to change.

Thank you for your understanding, please keep your families safe at this time.

Vision Therapy

Neuro-Optometry

Myopia Management

Dry Eye

Referrals

Yonge Eyes Optometry