Join Now Step 1 of 10 10% First NameLast NameCollege Registration NumberPhone NumberGenderDate of Birth Date Format: MM slash DD slash YYYY Home Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Outreach and Community and Professional AffiliationsSociety Group MemberAre you a member of a local Society Group/Chapter? Yes No Society/GroupPlease specifySpeak to MediaAre you willing to speak on radio, television, or to a print journalist about optometric issues? Yes No AdvocacyAre you interested in participating in political advocacy for the profession? (Ex: Contact your MPP or participate in a political fundraiser?) Yes No Community EventsAre you willing to participate on behalf of the OAO in community events such as health fairs, presentations to local groups, schools, or companies? Yes No Commmunity Club/AssociationWhat community club or professional association do you belong to? Education and TrainingDegreeDid you obtain an Accredited Professional Optometric Degree? Yes No Institution Name (POD)If yes, please provide institution name and year of graduation: Graduation YearInternational Optometric Bridging ProgramDid you complete the International Optometric Bridging Program? Yes No Institution Name (OBP)If yes, please provide institution name and year of graduation: Graduation YearDesignationsList any Degrees and Professional Designations (eg FAO, MSc, etc) Practice Information: GeneralBusiness/Practice NameBusiness/Practice NameAddressAddressCityCityProvinceProvincePostal CodePostal CodeCountryCountryPhone NumberPhone NumberFax NumberFax Number Practice Information: Available FacilitiesAvailable facilitiesSelect all available facilities at this practice Select All Dispensing Office Wheel Chair Accessible Entrance Wheel Chair Accessible Examination Room Handicapped Washroom Ramps ESEL Practice Optical Coherence Tomography (OCT) Heidelberg Retinal Tomography (HRT) Corneal Topography Visual Fields - automated Digital Retinal Imaging/Fundus Photos Other Please specifyPlease specifyPractice Information: Services OfferedAvailable facilitiesSelect all services offered by this practice Select All Infant Examinations (6-24 mos) Pre-School Children Examinations (2-5 yrs) Home Visits Visits to Institutions Physically challenged patient care Mentally/developmentally challenged child care Mentally/developmentally challenged adult care Glaucoma care Laser Refractive Pre/Post-Operative Care Occupational Safety Sports Vision Vision Therapy/Binocular Vision Training Visual Perception Testing Low vision Low vision Assistive Devices Program (ADP) Authorizer Specialty Contact Lenses Specialty Contact LensesPlease select all that apply Select All Orthokeratology/Corneal refractive therapy Scleral lenses Contacts for Keratoconus Hard contacts/rigid gas permeables Services Offered (Other) Other Please specifyPlease specifyAdd Practice Practice Information: General Address City Province Country Postal Code Phone Number Fax Number Available facilities Other Available facilities Specialty Contact Lenses Services Offered (Other) Actions Edit Delete There are no Pratices. Add Practice Maximum number of pratices reached. Mailing InformationMailing informationPlease select where Association mail should be sent. Home address Practice address Other AddressAddressCityCityProvinceProvincePostal CodePostal CodeCountryCountry Languages SpokenLanguages spokenPlease select all languages in which you are fluent Arabic Armenian Bengali Burmese Cantonese Croatian Dutch English Farsi Filipino Finnish French German Greek Gujarati Hebrew Hindi Hungarian Italian Japanese Korean Kutchi Mandarin Polish Portuguese Punjabi Russian Sign Language Singhalese Slovak Spanish Swahili Tamil Ukranian Urdu Vietnamese Yiddish Other Language (Other)Please specify Patient and Public ReferralPatient/Public ReferralOAO receives calls from the public inquiring about services provided by optometrists. Would you like OAO to refer patient/public inquiries to you in your practice when asked for an optometrist that provides specific services or speaks a certain language? Yes No Consent to receive electronic communicationsConsent I agree to receive electronic communications from OAOOn July 1, 2014 Canada's anti-spam legislation came into effect. OAO is required to obtain consent to communicate electronically with members. OAO uses commercial electronic messages as the main communication vehicle to update and inform members on OAO initiatives and programs in areas of advocacy, community, education and governance and CAO through associated national membership. Electronic publications sent to OAO members includes: E-blasts, E-vites and President's Reports and Notices. You may unsubscribe at any time by sending an email to email@example.com or by selecting the UNSUBSCRIBE option found in our published messages. ConfirmationBy submitting this form, I hereby apply for a membership in the Ontario Association of Optometrists (OAO). I agree to abide by its constitution, bylaws, and Ethical Guide for OAO Members, and to promptly advise the OAO of any change in practice location. As an OAO member, I understand and agree that my name, practice address(es) and practice phone number will be posted on the OAO website for public access through the 'Find an Optometrist' program. Unless otherwise stated. information (other than noted above) requested in the following pages is kept confidential and will be used by OAO solely to: 1. Develop policy and proposals advocating for the profession with the Ontario government; 2. Evaluate and expand member resources, benefit programs and services. CommentsThis field is for validation purposes and should be left unchanged.