Please complete this form prior to your first appointment at Custom Eyecare.
This form is for patients aged 15 years and under. For patients aged 16+ please complete our adult form.
Custom Eyecare will be closed for our Christmas break from Friday 23rd December at 5pm, and reopening Tuesday 3rd January at 9am. During this time, please leave us a message on 49270500 or shoot us an email on info@customeyecare.com.au and we will get back to you asap. Any online orders will be sent out after we reopen on the 3rd Jan, 2023.