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Optometrist At Holly & Derry in Milton, ON

Call 905-876-0044
Schedule An Eye Exam
Home » Contact Us » Patient Registration Form

Patient Registration Form

In addition to the Patient Registration Form below, please sign and submit our Covid-19 Declaration

Each form must be submitted individually, by hitting the submit form on the bottom of this page, as well as on the bottom of the Covid-19 Declaration page

Please make sure to click on the submit button of this form prior to clicking on the Covid-19 Declaration page