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Referral Form

VT Referral Form

  • Date Format: MM slash DD slash YYYY
  • I hereby grant permission for Dr. K. Dolman and any other professional involved in my care to exchange information concerning my case, history, results of the examination, diagnoses, treatment, etc. I also hereby give my permission to have this information faxed to Dr. K. Dolman so that her office can contact me (or my appointed representative) to schedule an evaluation.
  • I hereby agree
  • I have obtained consent from the patient

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COVID-19 Changes to Availability

Under the advice of the Chief Medical Officer of Health Ontario, our office is closed to in-person care until further notice as a precaution to help protect our patients, team members and the community against the spread of COVID-19.

Should you experience an eye emergency or concerns about your eye health, please email or call (519-662-3340).

If you are in need of contact lenses, we offer free direct ship. If you have an eyeglasses emergency, we will do our best to help you.

A team member will be responding to messages and answering the phone between the hours of 10:00 am and 12:00 noon, from Monday to Friday.

We apologize for any inconvenience. Once our office reopens, we will reschedule your appointment.

Follow us on Facebook and also on Instagram for realtime updates!

We appreciate you patience and understanding during this very difficult time.

Sincerely, and with best wishes,

The Dolman Eyecare Team