Glasses To Go

Mobile Vision Care Services

Book Eye Exam

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Eye Exams

Book your eye exam using our convenient online form below and choose the payment option of your choice.

Our Eye Examination Booking form can be submitted online or printed out and mailed with payment to:

Glasses To Go

93 Courtenay Terrace

Sherwood Park, AB T8A 5S6

E-transfer funds can be sent to glasses2go@shaw.ca (auto deposit-no password required)

Book Your Eye Exam

for office use only

Today's Date

Patient Suffix*

First name*

Last name*

Patient's Address*

Address of where the patient resides (private residence, Care Centre or hospital)

Patient's Name of Building if an apartment or residence or hospital*

Please add the room number and floor number if applicable

City

Province/State

Postal/zip Code

Phone number where patient can be reached*

Phone number of patient's residence, room, unit, nursing station etc.

Type of location

Building

Nursing station

Private room/Home

Residence

Name of family contact/guardian if applicable

First name

Last name

Phone

If there is a public trustee, please indicate name and phone number

First name

Last name

Phone

Does the family contact/guardian want to attend the eye exam visit?

Yes

Authorization to release medical records including past eye exams to our optometrist

First and last name of patient*

By typing the patient's name, I (the authorized family contact/guardian/public trustee) give consent to release medical records

I authorize the release of medical records (including past eye exams) to the Glasses To Go optometrist*

Yes

List any patient health concerns/medications/conditions that the doctor should be aware of prior to appointment

Eg. best time of day to see patient/diagnosis such as diabetic/use of both hands/exam's purpose to upgrade prescription for reading,TV or distance correction

Are new frames and lenses required?*

Yes

Address that our eye exam receipt should be mailed to if other than the patient's address (eg. office of the Public Trustee)

ATTN: Please type who we need to send the receipt to*

Address to mail eye exam receipt*

City*

Province*

Postal/zip Code*

Terms of On Site Eye Exam & Service

On site call fee: Includes 2 visits for fitting and adjustments of a complete pair of eye glasses within the first year.

Eye exam policy: 30 days from time of assessment for recheck and lab redo, if required. Frame only is a final sale with no warranty and no exchanges.

Complete order placed but not processed within 30 days of issues receipt are considered final sale with no exchanges or refunds.

Orders cancelled or changes to original order are subject to a restocking fee of 25% and require original receipts to be changed or cancelled. If there is no receipt it is considered a final sale.

Warranty is limited to manufacture defects only. Warranty is void if frame and lenses are glued, soldered, have dog teeth marks or any other abuse to the original frame or lenses.

Fee Schedule - Please contact our office by phone if you want information regarding our fees. We accept payment by etransfer for our onsite call fee for the eye exam.

Christine Zacharko holding a pair of glasses

Friendly Reminder: Both the online form and payment must be sent to our office in order to be seen by our optometrist

Glasses To Go

On site eyewear consultation and fittings (private home, nursing home, office, hospital or other facilities) and at trade shows

Serving Sherwood Park, Edmonton, St. Albert, Leduc, Fort Saskatchewan, and surrounding areas upon request

Contact

Web: www.glasses2go.ca
Email: glasses2go@shaw.ca

Phone: 780-916-6646

Address: 93 Courtenay Terrace
Sherwood Park, AB
T8A 5S6

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Eye Exams

Book your eye exam using our convenient online form below and choose the payment option of your choice.

Our Eye Examination Booking form can be submitted online or printed out and mailed with payment to:

Book Your Eye Exam

Terms of On Site Eye Exam & Service

​

​

Fee Schedule - Please contact our office by phone if you want information regarding our fees. We accept payment by etransfer for our onsite call fee for the eye exam.

in