Request an Appointment

New and current patients are invited to call us or complete the form below to make an appointment.

Appointment Request Form

Fields marked with * are required.

Please fill out the form below to assist us in booking your appointment. We will contact you within 24 hours with an appointment time. We look forward to seeing you!

Your Contact Information

Heard about office from *

New or Returning Patient? *

First Name *

Last Name *

Street Address *

City *

Province *

Postal Code *

Phone (primary) *

Phone (alt)

Date of Birth *

Family Doctor *

Appointment Details

Reason for Appointment *

Preferred Appointment Time *

Request appointment with *

Additional Information (optional - for faster check-in)

Insurance Provider

Insurance Policy Number

MSI Number

Medical problems (please describe)

History of eye diseases or surgery

General medications

Eye medications

I primarily use my eyes for

Sports/activities I enjoy

Enter the letters you see:

Bedford Eye Care Centre | Drs. Mandelman, Dobson, Cox & Parkash | Associates in Optometry | Sunnyside Mall | Bedford, NS

tel 902.835.2020

From our Learning Centre

Bedford Eye Care Centre Welcome Video

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Request an Appointment

Appointment Request Form

Your Contact Information

Appointment Details

Additional Information (optional - for faster check-in)

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