Request an Appointment To request an appointment, please fill in the following form by clicking the next button below. We will contact you as soon as we have an appointment available for your needs. If you are experiencing an urgent issue, please call your local practice. Back Next Contact Information Please fill in the below sections with your contact information so that we can contact you when we have an appointment for you Full Name* Contact Number* Email Address* Postcode* Back Next Appointment Needs Please complete the below to help us find the most suitable appointment for you. What type of appointment do you require?* Sight Test Contact Lens Checkup Sight Test & Contact Lens Checkup Contact Lens Trial Repair / Broken Spectacles Lost / Replacement Spectacles Additional Spectacles / Prescription Sunglasses Age bracket for appointment? Under 16 16-18 19-59 60-79 80+ Back Next Repair Details regarding the damage, frame model etc* If possible, please upload an image of the damage. Drag & Drop Files Here Browse Files Back Next Sight Test / CLO What has prompted you to make an appointment?* Routine appointment due Experiencing problems with or a change in my vision Other Are you currently experiencing any of the following issues with your eyes?* Dry, watery or uncomfortable eyes Headaches Double vision Tired eyes Flashes or floaters None of the above Other If you have noticed any new flashes of light and / or floaters (little dots or cobwebs moving around in front of your eye/eyes) in the last 6 weeks, please contact your closest practice by phone straight away so that an appropriate appointment can be arranged or alternatively call 111. Click here to find your closest practice along with their telephone number. Are you experiencing any of the following issues with your vision?* Difficulties with distance vision Difficulties with mid-distance (tablet, laptop, dashboard) Difficulties with near vision (watch, small print, smartphone, fine detail) None of the above Back Next Is this your first appointment at Haine & Smith?* Yes No Back Next Which practice would you prefer to visit?* Please Select A Practice Amesbury Calne Chippenham Cirencester Corsham Devizes Faringdon Gorse Hill Highworth Malmesbury Marlborough Melksham Pewsey Regent Street Tetbury Trowbridge Warminster Westbury Wootton Bassett Wroughton Let us know your availability below and we will do our best to find an appropriate appointment. Please be aware that we cannot guarantee availability, but will contact you to offer the closest possible appointment time. Please select which days are suitable for you* Monday Tuesday Wednesday Thursday Friday Saturday Please select which times are suitable for you* 09:00-11:00 11:00-13:00 13:00-15:00 15:00-17:00 Can you travel to another one of our practices to be seen?* No Yes - To nearby practices Yes - I'm happy to travel to any Haine & Smith Other Comments Are you able to wear a face covering to your appointment?* Yes No Privacy Policy* I have read and agree to the Privacy Policy Submit Back Next Click here to view our guide to your next appointment
