The Eye Emporium

Book an Eye Examination

If you would like to request an eye examination online then please complete this form and we will contact you by telephone during opening times, 9:30am - 5:30pm from Monday to Saturday and 11am - 5pm on Sundays including Bank Holidays, to confirm your appointment.

Personal Details

Title* Please select an item.
Name* Please enter your name.
Email Please enter a valid email address.
Telephone* Please enter a contact number.
Date of Birth* Please enter your date of birth.Please enter a valid date of birth.
Postcode* Please enter your postcode.
Medical Conditions glaucoma Please make a selection. diabetes Please make a selection.

Appointment Details

1st date* Enter a date.Invalid format. morning afternoon
2nd date Invalid date. morning Please make a selection. afternoon Please make a selection.
3rd date Invalid date. morning Please make a selection. afternoon Please make a selection.