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Phoropter
New Patient

NEW PATIENT DETAILS

NEW PATIENT DETAILS

Before making a booking as a NEW PATIENT, please fill in and submit your details on-line below. Alternatively, you can download forms by clicking the  "Download Forms"  Tab above and either print and fill out manually or you can fill in digitally and email to lizelledsmith@gmail.com

Once Patient details have been filled in and submitted, you can proceed to BOOKING AN APPOINTMENT.

NEW PATIENT DETAILS
DETAILS OF MAIN MEMBER OF MEDICAL AID
NEXT OF KIN

Please proved details of a next of kin who does not stay with you

I,

Take full responsibility to pay any monies owing to Dorfling-Smith Optometrists for services rendered.

Thank you for your submission. We look forward to welcoming you. Please proceed to BOOK AN APPOINTMENT

Download forms

DOWNLOAD FORMS TO FILL & SIGN

DOWNLOAD FORMS

If you have already booked an appointment telephonically or via email then please download and fill out forms below (either by printing and manually filling out / or you can fill in digitally) and email back to lizelledsmith@gmail.com - Thank you

If you would like to fill in information on-line and make a booking, please click on "New Patient" tab or "Existing Patient" tab above.

Book an Appointment

Please make sure to download & sign our Privacy Notice before your appointment - CLICK HERE to download

Bookings
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