Brantford Optical
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Youth OHIP exam (age 19 and under)
Saturday, Jan 9, 2027
at
1:40 PM
with Dr. Singh
Website
Your Full Name
Email
Phone (10 digits)
Type
Mobile
Home
Office
Other
Date of Birth (optional)
Age on appointment date:
Comments (optional)
Do you have Diabetes and/or Glaucoma, and/or take: hydroxychloroquine, chloroquine, tamoxifen, or ethambutol?
Select…
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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