Brantford Optical
« Back to times
Diabetic Senior
Tuesday, Dec 22, 2026
at
2:20 PM
with Dr. Daid
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
Book It
Cancel
