Request An Appointment 

Feel free to use this form, or give us a call at 905-665-5478 (Whitby) or 905-239-5678 (Ajax) to schedule an appointment. We will call or email to confirm all appointment details during our regular business hours.

We cannot guarantee that your preferred date will be available but will do our best to find a day and time that works for you!

At our Whitby location we are often booking appointments three weeks or more in advance from the current date. 

The doctors are often available Monday through Saturday at either our Whitby Or Ajax location.

Name *
Phone Number *
Phone Number
Home Address *
Home Address
Date of Birth *
Date of Birth
Preferred Appointment Date
Preferred Appointment Date
Appointment Location *
Please pick the location for your appointment

By submitting this form, you are granting: Inspired by Rossland Optical, 220 Taunton Rd E, Whitby, ON, L1R 0M5, permission to email you.