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Kanata Bridlewood Optometric Centre

1-701 Eagleson Rd
Kanata, ON  K2M 2G1
Phone: 613-599-6868

info@kboc.ca


Hours

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We will contact you soon to confirm your appointment or to answer your question.
Thank you!
<% else %>

Request an appointment/Contact Us

Subjet:  

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New patient >   Existing Patient >                         <%'=ValidateMessage("FieldBlank","Patient","","Patient type mandatory")%>

Referred by:  

"> <%'=ValidateMessage("FieldBlank","referred","","Référant obligatoire")%>

Title:  

* Full Name:  

"> <%=ValidateMessage("FieldBlank","Name","","Name mandatory")%>

* Telephone:  

"> "> "> <% if Request.Form("Send") <> "" and (Validate("FieldBlank","CodeRegional","")=false or Validate("FieldBlank","Tel1","")=false or Validate("FieldBlank","Tel2","")=false) then writeMessage("Phone number mandatory") end if %>

Other Number :

"> "> ">

* Email:  

"> <%=ValidateMessage("FieldBlank","email","","Email mandatory")%>

Appointment request:  

   

Preferred time:  

 

Message/comments:


    

<% end if %>

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