Request an appoinment Doctor ReferralsPlease fax our clinic at the number below. FAX905-822-3030 REFERRAL FORM Name * First Name Last Name Email * Phone * (###) ### #### Date * MM DD YYYY Please Select Below * -- Select from List -- Optometry Blepharoplasty (Upper/Lower) Fotona Laser Treatments Injectables Please Specify * Thank you! Your request has been submitted.
