Patient Registration Form

Registration Form

Please complete the information below prior to appointment and submit the form online. This form contains confidential information and is delivered to your doctor through a secure Internet connection.

Name

Address

Contact Information

Personal Information

Additional Family Members

Please complete if multiple members of your family have an appointment.

#1

#2

#3

#4

#5

Manitoba Health Card

Please bring your Manitoba Health card to your appointment.

Primary Insurance (Optional)

Please bring all insurance cards with you to your appointment.

Secondary Insurance (Optional)

If you have coverage through another plan/organization, please fill in the details below.

Comments

If you have any comments you would like to add, please enter them here.

Enhanced Eye Exam

A dilated eye exam allows the doctor to get a much better, more thorough view of the back of your eyes by making the pupil (the black part of the eye) much larger. This requires the optometrist to put drops into your eyes which may cause sensitivity to light and blurry vision up close for 4-6 hours. Dilated eye exams are strongly recommended for all patients.
Unsure? Our Doctor would be happy to discuss during the exam. The fee associated with a routine dilated eye exam is an additional $40. In some cases, this service may be covered by Manitoba Health.

Privacy Policy

I authorize the release of medical and other information acquired in the course of my examination and/or treatment to the necessary insurance companies, third party payors, &/or health practitioners required to participate in my care. I authorize/ request my insurance company to make direct payment to Sage Creek eye centre . I understand that I am financially responsible for charges not covered by my insurance plan. *Accepted forms of payment: Cash, Visa, Mastercard, American Express, Interac.
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“This is a really exceptional eye care practice! My kids and I both go here and the whole team are incredible. They're kind, helpful and personable with grown ups and little ones. Our doctor is really thorough and explains everything well. Really impressed with the care we receive here from everyone. Keep up the great work!”Erin Cummings Google Review
“Both my husband and I had eye exams today with Dr. Enns. We were very impressed with the facility, equipment, and Dr. Enns. She is wonderful with her patients and explains everything. Would highly recommend her and Sage Creek Eye Centre for your next eye exam. My husband says it is the best eye exam he has ever had and he has had a few!”Martha V Google Review
“Highly recommended based on level of care, expertise and ability to meet my exact needs. At the start of the pandemic, remote work was hard on my eyes and they were great at accommodating my needs. I left understanding more about my own role in my eye care health and tooled with amazing glasses that keep my eyes in check!”Amy Nadeau Google Review
“I highly recommend! I recently moved to the area and required an adjustment to my glasses. I was greeted right away and out the door in minutes. No charge for repair. I will be going here for my future eyewear needs.”Craig Gillon Google Review
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