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Edmonton Eye Doctor
- FAQs with Dr Moe
- Our Story
Scleral Lenses
Myopia Management
Eye Care Services
- Eye Disease Management
Glasses & Contacts
Insurance

Home » Contact Us » Referral Form

Referral Form

Date of Referral

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Patient Name

First Last

Phone #

Alberta Health Care #

Referring Doctor Info

Name

First Last

Clinic Name

Clinic Phone #

Clinic Fax #

Reason for Referral

Referral Services

Diabetic eye exam

Neuro assessments with visual fields

Dry Eye assessment

Blurred vision or vision loss

Vision Therapy assessment

Plaquenil retinal screening

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Patient History Form

Thompson Optics

11208 104 Ave NW
Edmonton, AB T5K 2X4

Phone: 780-425-5367
Email: info@thompsonoptics.com
(Do not send personal health information by email.)

Monday: 9:00 AM - 5:30 PM
Tuesday: 9:00 AM - 5:30 PM
Wednesday: 9:00 AM - 5:30 PM
Thursday: 9:00 AM - 6:30 PM
Friday: 9:00 AM - 5:30 PM
Saturday: 9:00 AM - 2:00 PM
Sunday: Closed

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Thompson Optics
11208 104 Ave NW
Edmonton, AB T5K 2X4
Phone: 780-425-5367
https://www.thompsonoptics.com

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