Brantford Optical
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Medically Covered Exam (ie. Diabetic)
Saturday, Jan 9, 2027
at
11:40 AM
with Dr. Singh
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Your Full Name
Email
Phone (10 digits)
Type
Mobile
Home
Office
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Age on appointment date:
Comments (optional)
Do you have Diabetes and/or Glaucoma, and/or take: hydroxychloroquine, chloroquine, tamoxifen, or ethambutol?
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Yes
No
What will your age be on the date of your exam?
Do you currently have coverage through Indigenous Services, ODSP, or OW?
Select…
No
Indigenous
ODSP
OW
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