Request an eye test appointment | Colin O'Leary Opticians Pontyclun

If we’re closed, please use our form below to let us know when you’d like your appointment. When we re-open, we’ll get back to you either to confirm or to reschedule.

Please allow up to 48 hours for a reply.

Type of appointment*

Eye testContact lens appointmentEye test and contact lens appointment

First preferred date/time

Second preferred date/time

Are you an existing customer?*

YesNo

Do you have diabetes or a family history of glaucoma?

DiabetesGlaucoma

Title

Full name*

Mobile number*

Alternative contact number

Email address*

Your date of birth*

Address line 1*

Address line 2

Town/City*

Postcode*

GP Name

From time to time, we may want to send you promotional information and offers. Your information will not be shared with any third parties and you will be able to unsubscribe at any time by contacting us. If you do not want to receive these communications, make sure that this box is not ticked.

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