Appointment Request Form
*PARENT'S / CAREGIVER'S NAME:
Please enter English alphabets only.
*CHILD'S FIRST NAME:
Please enter English alphabets only.
*CHILD'S MONTH/YEAR OF BIRTH:
*PARENT'S / CAREGIVER'S EMAIL:
*PARENT'S / CAREGIVER'S MOBILE:
*ARE YOU INTERESTED TO FIND MORE ABOUT MYOPIA CONTROL PRODUCTS
Select your answer
Yes
No
*WHICH EYE CARE PROFESSIONAL WOULD YOU LIKE TO VISIT
Select your eye care professional
Central - Bukit Timah Plaza - Mee Mee Optics
Central - Orchard Tower - C C Chui Optical Company
Central - Parkway Parade - OJO Optometrist
Central - 313@Somerset - Mee Mee Eyecare
Central - People's Park Centre - Pearl's Optical
Central - Queensway Shopping Centre - Optique Zone
Central - Sin Ming Plaza - AeroV
Central - City Gate - Pearl's Visioncare
Central - Tiong Bahru - Tiong Bahru Eyecare
Central - Paragon - Philip D Izaac
Central - Junction 8 - Optique Paris Miki
Central - Thomson Plaza - First Contact Lens Centre
Central - Bugis Junction - Optique Paris Miki
Central - Parkway Parade - Optique Paris Miki
Central - Plaza Singapura - KJ Optometrists
Central - Far East Plaza - First Eyewear Centre
Central - Mandarin Gallery - The EyeClinic by Dr Cheryl Lee
Central - United Square - PRECISION OPTICS
Central - Plaza Singapura - OPTIQUE PARIS MIKI
Central - Takashimaya - OPTIQUE PARIS MIKI
Central - Holland Road Shopping Centre - OPTIQUE PARIS MIKI
Central - Toa Payoh - PEDIAOPTIX INTL
Central - Royal Square Novena - DR NATASHA LIM EYE CENTRE
Central - Square 2 - UNIVERSAL OPTICAL
Central - Mount Elizabeth Novena - Adult & Child Eye (ACE) Clinic
Central - Leisure Park - EYE THEORY
Central - Bukit Timah Plaza - Ming Ming Optical
Central - Marine Parade - THE LENS MEN
Central - People's Park Complex - ASSOCIATED OPTICAL CO
Central - Orchard - IGARD
Central - Tiong Bahru - Your Eye Guardian
Central - South Bridge Road - The Eye Place
Central - King Albert Park - Owl Optics
East - Tampines 1 - OJO Optometry
East - East Coast - First Eyewear Centre
East - Eastpoint Mall - Kai Joo Optometry
East - Tampines - Eyesight.sg
East - Tampines Hub - Pearl's Visioncare
East - Singpost Centre - KJ Optometrists
East - Tampines - Helen Optometrists
East - Tampines 1 - OPTIQUE PARIS MIKI
East - Century Square - UNIVERSAL OPTICAL
East - Tampines - VISION 27
East - Siglap Centre - Siglap Optical
East - Tampines - Tampines Optical
East - PLQ Mall - J Glasses
East - Loyang Point - Lens Vision
East - E!Avenue@Downtown East - Eyes 2 Eyes
East - Eunos - I'S Concoctions
Kinex - Lucid Eyecare
North - Sun Plaza - MANCHESTER EYEWEAR
North - Sun Plaza - OPTIQUE I.C.U.
North - Yishun - 66 Optics & Contact Lens Centre
North - Northpoint - Optical 88
North-East - Potong Pasir - Eyesight.sg
North-East - Nex - Eyecare Studio Optometrist
North-East - Hougang Mall - Kai Joo Optical
North-East - Heartland Mall - Pearl's Visioncare
North-East - Boon Keng - Infinity Eyewear
North-East - Ang Mo Kio - City Eyehub
North-East - Seletar Mall - Eyecare Studio Optometrist
North-East - Serangoon - NAN FANG OPTOMETRISTS
North-East - Hougang - MEI LIM OPTICAL
North-East - Rivervale Plaza - PRO EYEZ OPTOMETRISTS
North-East - Woodleigh Mall - Eyecare Studio Optometrist
North-East - Hougang - Iprofessionals Optical
North-East - Hougang - Visual Art's Optics
North-East - Hougang Mall - Crystal Optics
Hougang - Choice Optical
South - Vivocity - OPTIQUE PARIS MIKI
South - Gleneagles Hospital - LUMIN EYE SPECIALIST
South - Gleneagles Hospital - Hesed Eye Specialist
West - Jurong West - Ong's Optics & Contact Lens Centre
West - West Coast - De Eyewear
West - West Mall - Mr Eyewear
West - Clementi - NGEE ANN POLYTECHNIC
West - Jurong Point - Eyecare Studio Optometrist
West - Clementi - Straits Optical & Contact Lens
West - Bukit Batok - Grand Optical & Contact Lens
West - Jurong - Grand Optical & Contact Lens
West - Jurong West - Feng Yang Eyecare
West - Bukit Gombak - Sunny Optics & Contact Lens Centre
West - Jurong Point - Optical 88
*DESIRED APPOINTMENT DATE:
*DESIRED APPOINTMENT TIME:
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
1:00 PM
1:15 PM
1:30 PM
1:45 PM
2:00 PM
2:15 PM
2:30 PM
2:45 PM
3:00 PM
3:15 PM
3:30 PM
3:45 PM
4:00 PM
4:15 PM
4:30 PM
4:45 PM
5:00 PM
5:15 PM
5:30 PM
5:45 PM
6:00 PM
6:15 PM
6:30 PM
6:45 PM
7:00 PM
With your consent, Johnson & Johnson International (Singapore) Pte Ltd (Company/We/Us), will collect, use, and process your and your child’s personal data to enable us [i] arrange appointment booking with the selected Eye Care Practitioner based on the provided details, [ii] include you in the Company’s Customer Relationship Management database, and [iii] send you eye healthcare product information and updates, promotional materials and marketing communications. We process personal data in accordance with our Privacy Policy which you may view at
[https://www.seeyourabiliti.com/sg/parents/privacy-policy]
. If you do not provide us your and your child’s personal information, we would be unable to carry out the above purposes. We may disclose your and your child’s personal information to Johnson and Johnson affiliates and to our selected Eye Care Professionals and our authorized service providers for the purposes described in this Privacy Notice.
Yes, I agree to receive messages on eye healthcare products and services, events, programs and activities, and marketing and promotional communications from J&J, through SMS, email, or other media platforms.
*Mandatory fields