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Pre-Examination Form for Your Visit to Langley Optometry Clinic

Enjoy the Fun and Professional Care from Langley Optometrists

Maybe you wish to switch from glasses to contacts. Maybe you like glasses but simply want a more stylish set. Perhaps you have a more serious concern that you need diagnosed, or you want to explore the possibility of laser-eye surgery.


Whatever you need, consider visiting Langley Optometry for a solution. We can provide you with a variety of optometric services, including:

  • Diagnosis
  • Prescriptions
  • Glasses (for your sight and for your sense of style) or contacts
  • Speedy service thanks to our on-site lab

We love working with you, and we will make your experience as pleasant and fun as possible.


Experience Ready Service and an On-site Lab

We do eye exams for all ages. Our on-site lab allows us to quickly fix your glasses, refurbish your beloved old frames, or provide you with a customized new set. Here are some of the vision correction options available on-site:

  • Rigid contact lenses
  • Keratokonic contact lens fitting
  • Glasses
  • Sunglass both prescription and non-prescription
  • Contact lenses
  • Artificial tears
  • Contact lens solution
  • Ocular vitamins
  • Lid cleansers

We can also prescribe medications for the following:

  • Allergies
  • Infections
  • Inflammations

Find All Your Eye Solutions in One Place

We offer a wide range of optometric services for all family needs. You don’t need to look any further for an optometrist in Surrey or Langley.


Don't forget to ask us about the following:

  • Package deals on glasses
  • Senior discounts
  • Student discounts

Call Today!

Call (604) 534-4312 for professional service from our Langley optometrists today!

Male
Female
Yes
No

If you have NOT already booked an appointment for an eye examination with us, please indicate in the boxes below up to three tentative dates that are convenient for you to come in for your eye exam. We will contact you to book your appointment as soon as possible.

Your Vision

Laser Surgery
Crossed Eyes
UV Exposure
Lazy Eye
Low Vision
Diabetes

Eyewear and Lens Options

Disposable
Coloured
Daily Disposable
Part-Time Wear
Continuous Wear
Rigid Lenses
Multifocus
Driving
Computer
Reading
Progressives
Safety Wear
Thin Lenses
Glare Free
Polarized
UV Protection
Clip-Ons
Tinting
Transition
Golf
Fishing
Swimming
Skiing
Hockey
Tennis
Soccer
Cycling
Jogging

Prescription History

Please list all medications that you are currently taking including vitamins in the box below.

Thank you for completing this form. We look forward to seeing you at your next visit!

Address

20430 Douglas Cres.

Langley, BC V3A 4B4


Phone: 604-534-4312

Fax: 604-534-8092


Email

info@langleyoptometry.com

Hours

Monday-Wednesday: 8:30 AM to 5:30 PM
Thursday: 10:30 AM to 6:30 PM
Friday: 9:30 AM to 5:00 PM
Saturday: 9:00 AM to 1:30 PM
Sunday: CLOSED

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