Appointment Request

To make life easier and avoid sitting for too long in the waiting room you can request your appointment ahead of time. You can call our clinic; make an in person booking; or use our online appointment request form below. Someone from our booking desk will contact you to confirm or suggest an alternate appointment within 24 hours of your online request.

Please remember this is a request, not a booking. Our clinic staff will review your information and get back to you to confirm the appointment. If the appointment time or physician you request is not available we will suggest a new appointment.

Have you been to our clinic before?	...Select Yes No
Do you have a Doctor you would like to request?	...Select Yes No
If so, which Doctor?
When would you like an appointment?
First Name (as printed on valid Health card)
Last Name (as printed on valid Health card)
Birth Date:
Sex:	Male Female
Address:
City:
Postal Code:
Phone Number(s):
Email:
MHSC Number (6 digits)
PHIN Number (9 digits)
Reason for Visit (optional)