Please use this form to request a new appointment only. If you wish to cancel or modify an existing appointment, please call our office at 905-876-4701.

Also, please contact us by telephone or see us in person if your request is of a confidential or private nature.

All fields must be completed in order to submit the form.

 

Name
Address
City
Province
Postal Code
Email
Phone

 

What is your patient status? New Patient  Existing Patient
What is the best time to contact you?  
Morning  Noon  Afternoon  Evening  Any time

 

What day do you prefer for your appointment?
Mon  Tues  Wed  Thurs  Fri  Any day
What is your preferred appointment time?
Morning  Noon  Afternoon  Evening  Any time
Please describe the nature of your appointment: (eg: cleaning, cosmetic)
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