You can download this PDF and submit that to us, the interactive form is coming soon.
I, patient name above authorize, authorize the release of eye care information for the patient(s) outlined below, to (Dr. Hesla / Dr. LeVasseur) at Hesla Optometry on
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Note: This transmission, including attachments, is intended only for the named recipients above and may contain information that is privileged, confidential, and/or exempt from disclosure under applicable law. If you received this in error, please notify the sender immediately by calling 403-262-2958 and destroying this transmission. Thank you in advance.
