DEMANDER UN RENDEZ-VOUS
WE WILL CONTACT YOU TO PROPOSE AN APPOINTMENT DATE.
Please complete the form below and send it back to us by email (firstname.lastname@example.org)
(you can also print it out and bring it back the day of your consultation)
1) What is your first and last name?
2) What is your job ?
3) Do you have any allergies?
4) Do you have a general illness?
5) Do you have any eye disease?
6) Do you wear contact lenses?