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85 The East Mall, Suite 102
Etobicoke ON M8Z 5W4

Home » Contact Us » Appointment Request Form

Appointment Request Form

If this is an emergency, do not contact us via email, please use our emergency contact information.

Patient Forms:

Welcome Checklist

New Patient Form

Insurance e-Claim Authorization Form

Insurance e-Claim Benefit Assignment Form

Complete the following form to request an appointment:

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
  • :
  • This field is for validation purposes and should be left unchanged.