Our Practice
Eyecare
Eyewear
Contact Lenses
- Order Contact Lenses
- Orthokeratology
News
Contact Us
- Book an appointment

Our Practice
Eyecare
Eyewear
Contact Lenses
- Order Contact Lenses
- Orthokeratology
News
Contact Us
- Book an appointment

124 Maling Rd, Canterbury 3126
Opening Hours: Mon–Fri: 9.00 am to 5.30 pm Sat: 9.00 am to 1.00 pm

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(03) 9888 6377

Our Practice
Eyecare
Eyewear
Contact Lenses
- Order Contact Lenses
- Orthokeratology
News
Contact Us
- Book an appointment

Our Practice
Eyecare
Eyewear
Contact Lenses
- Order Contact Lenses
- Orthokeratology
News
Contact Us
- Book an appointment

BOOK AN APPOINTMENT

Welcome to Canterbury Eyecare Form

Welcome to Canterbury Eyecare, we ask that you fill out a few details for us ahead of your appointment.

Title

First name

Last Name

Preferred Name

Email Address

Date of Birth

Phone or Mobile Number

Residential Address

Postal Address (if different to Residential)

Occupation

Do you have private health insurance extras?

Medicare Number

Medicare Patient Reference Number

Medicare Expiry

When was your last eye test?

Do you wear glasses?

Do you wear contact lenses?

Please indicate if you have experienced any of the following:

Eye Injury Lazy Eye Cataracts Macular Degeneration Glaucoma Eye Infections Eye Surgery Heart Disease Diabetes High Blood Pressure Other

If you ticked "Other" please explain below:

Please indicate if anyone in your family has experienced any of the following:

Lazy Eye Cataracts Macular Degeneration Glaucoma Other

If you ticked "Other" please explain below:

Do you have specific visual needs?

Sports Hobbies Computer Sunglasses Other

If you ticked "Other" please explain below:

How did you first hear about us? If you were recommended by someone please write their name in "other" section below

Recommended by friend or relative Live and/or shop locally Referred by doctor or other professional Internet Other

If you ticked "Other" please explain below:

Consultation Fees

Full Initial Consultation:
Scheduled Fee $109.00
Standard Medicare Rebate up to $60.00

Retinal photos, 3D OCT Scan and Optomap:
Scheduled Fee $109 .00
No Medicare Rebate

Total $218.00

Subsequent and Contact Lens Consultations vary depending on presentation and prescription.
Medicare rebates dependent on date and type of last eye examination.

Privacy Statement

Our practice will deal with your personal information under the guidelines of the Privacy Act. We would like to send you occasional information regarding your eyecare and eyewear. Do we have permission?

Thank you and welcome to Canterbury Eyecare, please submit your information below.

Optometry Services

professional eyecare

designer frames

contact lenses

latest technology

Opening Hours: Mon–Fri: 9.00 am to 5.30 pm Sat: 9.00 am to 1.00 pm

124 Maling Rd, Canterbury 3126

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Acknowledgement of Country

Canterbury Eyecare acknowledges the traditional Aboriginal custodians of the many lands that we live and work on, and their continuing connection to Country and culture.