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Intake Form – to fill out once appointment has been booked

Welcome to Eye Q Optometry. We have a few questions for you to help us understand your eye health needs.
  • - Fever
    - Cough
    - Difficulty breathing
    - Conjunctivitis/red eye
    - Sudden loss of smell
    - GI upset
    - Travelled out of Canada
    - Had contact with someone who has travelled outside of Canada
    - Had contact with someone who tested positive for COVID-19 or currently being tested for COVID-19
  • Please note the following changes to our procedures until otherwise directed by the Alberta College of Optometrists:

    - We must keep our doors locked to better control patient flow through the gallery
    - When you arrive please call to notify us of your arrival
    - Upon entering the premises everyone will be asked to use hand sanitizer, or if you prefer we can provide hand soap and water to wash your hands
    - Everyone over the age of 5 will be required to wear a mask for the duration of your stay, bringing your own mask is strongly encouraged. People who need to be asked 3 times to place their mask back on will be asked to rebook their visit to a later date when masks will no longer be required. We do give an opportunity to take favorite frames outside where there is adequate space for patients to try on without a mask.
    - We ask to please be mindful of the 6 feet physical distancing measures when possible.

  • Please note we do offer the first appt of every day to elderly or immunocompromised patients on request.

    We are providing a safe place for our immunocompromised patients and please ask everyone to be respectful of the regulations imposed on us for the duration of this Pandemic.