Eyes and Lenses – Opticians

Kariba

Please fill in the form below to request the services of Eyes and Lenses – Opticians once we receive your enquiry, we will coordinate all necessary arrangements with the service provider on your behalf.

Section 1: Sponsor Information

Your full name

Your Email Address For booking confirmation

Your Phone Number* Include international code

Section 2: Patient Information

Patient Full Name Person receiving care or services

Patient Phone Number For follow-up or doctor call

Section 3: Appointment Preferences

Choose your preferred appointment timeframe. Emergencies (24hrs) are prioritized, standard bookings are done within 48hrs, and flexible options (72hrs+) let you select a specific date.

24 Hours (Emergency) 48 Hours (Standard Booking) 72+ Hours (Flexible)

Section 4: Additional Details

Additional Notes / Special Requests