RETURNING PATIENTS

Are you a returning patient? Here is a simplied form to request an appointment.

If you have seen one of our doctors at another clinic, but this is your first time at our Canary District location, please use the New Patient form instead.

First Name*

Last Name*

Email*

Phone Number*

OHIP Number

What is your preferred appointment time? Please check all that apply.*

Weekday Daytime

Weekday Evening

Weekend Daytime

I give permission to be contacted by email.*

Check this box to prove you're not a robot.*

* = Required field

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