Appointment Request Form

Monday: 11:45 AM - 8:00 PM
Tuesday: 8:00 AM - 5:00 PM
Wednesday: 8:00 AM - 5:00 PM
Thursday: 8:00 AM - 8:00 PM
Friday: 8:00 AM - 5:00 PM
Saturday: Closed
Sunday: Closed

Name: Heritage Optometric
Address: 130 Lansdowne Avenue,. Suite 6, Carleton Place, ON, K7C 2T7, CA
Price range: $000 - $300

Please fill in the form below to setup an appointment.
Reason for Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Phone*
Email*
Best Time to be Reached for Confirmation*

: HH

MM
Comments
Name
This field is for validation purposes and should be left unchanged.