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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 Clinic for a solution. We can provide you with a variety of optometric services, including:



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. Please fill out our pre-examination form below so we are ready for your first visit.

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


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:




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!


Are you a previous patient at Langley Optometry Clinic?

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

Eyewear and Lens Options

Contact Lenses
Sun Protection
Sport Vision

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!

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