Make an Appointment

In order to provide the most thorough eye examination we are able, we recommend that all patients should book our comprehensive examination; waiting times will be significantly longer for basic eye tests.

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Name *

First

Last

Please enter the relevant information

Title *

Date of Birth *

Patient ID (If known) *

NHS Number *

Telephone Number *

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Email *

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ADDRESS *

Required if you are new to the practice

What type of appointment? *

Comprehensive Eye Exam Basic Eye Test Contact Lens Aftercare Childrens (U19) Eye Test

Your preferred time? *

Morning Afternoon After 4.30pm (Thurs Only) Saturday (Morning Only) Any

Please select one

Is an upstairs room an option? *

Yes No

A stair lift is available to our new first floor consulting room.

Have we examined your eyes previously? *

Yes, I have had an eye exam with you before No, I am a new patient (Please complete the address field)

You are eligible for an NHS Eye examination if you: are over 60 or under 16 years of age or if you are under 19 and still in full time education. You can also be eligible if you: Are on income support or income based Jobs Seekers Allowance, Income-related Employment and Support Allowance, Pension Credit Guarantee Credit, Tax Credits or have an NHS Tax Credit Exemption Certificate. You are also eligible if you: Have an HC2 Certificate, are registered as partially sight or blind, if you suffer from Diabetes or Glaucoma or are considered at risk of glaucoma by the Hospital eye service, if you are the child or sibling of a person with Glaucoma and you are over 40 years of age, If you are a Prisoner on leave or if you have been prescribed complex lenses.

Any other relevant information? *

Please provide us with any other relevant information about your appointment. ie the reason for your visit, any recent ocular problems or diagnosis that you have had...etc.

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