Appointment
Appointment Information:
Step 1 / 4
Appointment Type
please select
Preferred Date
Appointment Time
please select
Your Details
Personal Information:
Step 2 / 4
First name
Last name
Date of birth
Gender
Please Select
Male
Female
Patient Id (if known)
NHS eligibility
Please Select
NOT Eligible
Eligible for Eye Test ONLY
Eligible for Help With Specs/Lenses
Not Sure
Contact Info
Contact Information:
Step 3 / 4
Email
Phone
Address
Postcode
Confirmation
Appointment Confirmation:
Step 4 / 4
Your Name:
name here
Practice Name:
Chase Meadow Opticians
Clinic/Optom Name:
Date / Time:
Date time here
GDPR Consent:
We collect and save your personal details for the purpose of booking this appointment. If you choose to cancel the appointment we will delete this information straight away. Going ahead with the appointment means that you will be stored on our database as a patient and are therefore covered by our standard GDPR policy.
Please confirm that you accept this
Appointment Booked:
Thank you for your appointment booking at Chase Meadow Opticians, you will shortly receive an email confirming your appointment.
