(Updated 12th July 2023)

Thank you for choosing us for your eye care needs, as a small independent family business, we appreciate your support.

This form is multi purpose & can be used to request an appointment for an eye examination or Minor Eye Condition service (MECs) appointment but is also a pre examination questionnaire for both new and existing patients. It is also a new patient registration form.

It will take approximately 5-10 minutes to complete.  

If you are requesting an appointment, the information we gather will be assessed by a member of our clinical team to assess the urgency of any symptoms or need . We will call you asap to arrange the most appropriate appointment type to best help you.

If you want to book an appointment to collect glasses, view frames, have a glasses repair or adjustment appointment or want to book a contact lens fitting or check up, you do not need to complete this form. Instead, please call 0208 293 9493 or email info@pageandsmallopticians.co.uk to arrange this.

This form also asks some questions about your eye history and lifestyle. Providing this information ahead of your appointment helps us to prepare for your appointment and run to time.

If you are completing on behalf of a child or someone you care for, please complete with their information. If you need to book for more than one person, you will need to complete a questionnaire for each person.

What happens next:

If you haven't booked your appointment yet, a member of our support team will be in contact as soon as possible to arrange a suitable appointment.

If you have difficulty completing this form, we can arrange a time to ask the questions on the telephone. Please call 0208 293 9493 to discuss how we can help.