BOOKING
A FIRST APPOINTMENT IN THE SPECIFIC LEARNING DIFFICULTIES AND VISUAL STRESS CLINIC



If you would like an appointment in this clinic then please fill in the form below and return it to us. Details of fees are on the next page. You will be required to pay this fee at the time of booking. The fee may be paid by cheque or credit card. This fee will only be refundable under exceptional circumstances.
Under exceptional circumstances, it may be possible to have the assessment for precision tinted spectacles carried out at the first appointment. If you feel that you will need or want to have this assessment carried out at your first appointment, please contact us to discuss this further..

NAME:
ADDRESS:
 
POST CODE:
PHONE:

Please telephone us to arrange an appointment for me/my son/my daughter in your Specific Learning Difficulties and Visual Stress Clinic. I enclose a cheque for £60/£102 (please see separate sheet for the appropriate fee), payable to 'The Institute of Optometry'.

SIGNED:
DATE:

Appointments secretary
The Institute of Optometry
56-62, Newington Causeway
London SE1 6DS