New Patient Sign-Up | Kathryn Anthony Optometry

Register Your Details

At Kathryn Anthony Optometry, we actively welcome new patients. All new patients are required to register their details to ensure an accurate record can be created going forward. This can be done in-person when you first visit, or should you wish to streamline the process, please pre-register your details below. We’ll then have everything to hand on your first visit, allowing you to relax without any further paperwork.

If you have any questions whilst registering, please call 01225 464433 and we’ll happy to assist you.

New Patient Form

Captcha

Personal

Title

First Name

Surname

Date of birth

Contact

Telephone

Address

House number or name

Address 1

Address 2

Address 3

Town

Post code

Medical

Registered GP practice name

Additional

This section is optional but any additional information regarding your vision or pervious eye examinations is helpful to know. Please leave these blank if you are unsure or wish to discuss in person.

Date of last eye exam

Previous optician’s practice

Have you had, or recently started to suffer from any eye issues, or have any additional questions you’d like to discuss?

Your First Visit

If you have a preferred day and/or time you’d like to first visit our practice, please let us know below. This does not guarantee availability or make a booking, but our receptionist will contact you on receipt of this form and look to arrange an appointment that matches as close to your preffered day/time.

Preferred date

Preferred time

Confirmation

I confirm the above details are correct and have read and agree to the terms and conditions

If you are human, leave this field blank.