Appointments

Usually our physicians see patients on an appointment basis. If you are experiencing problems, please call our office. We will arrange for you to see your physician as soon as possible.

To schedule an appointment, please call us at  (613) 425-6888

If you are unable to keep your appointment, please let us know as soon as possible. Our physicians make every effort to keep their appointments on schedule. Emergencies do arise, however, and sometimes a delay is unavoidable. When this happens, we do all we can to minimize the inconvenience. If an emergency occurs and you need to contact your doctor during office hours, call us.

Referral Form

If you're a physician and would like to refer a patient to us, please complete and submit the form below.

Alternatively, you may use the printable PDF form and fill it out by hand, then email/ fax it to us.

Our physicians will follow up within a few days as soon as we are notified.

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Patient's Information

Name

Please enter a first name

Please enter a last name

Date of Birth

Gender

Male

Female

Other

Status:

Urgent

Non-Urgent

OHIP/ Health Card Number

Contact

Please enter a phone number

Please enter an email

Address (Optional)

History

Provisional Diagnosis

Attachments
(max 10 files)
.jpg .png only

Upload Images OR Drag & Drop images here

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Referring Doctor's Information

Name

Please enter your first name

Please enter your last name

Contact

Please enter a phone number

Please enter an email

Please enter your OHIP Billing Number (6 digits)

Practice Address

I certify that the above information is accurate and have the patient's permission to use it for the purpose of this referral

You must agree before submitting.

Send a copy of the completed form to my email

Note: To ensure all transmissions are encrypted using TLS 1.3, we enforce HTTPS; if your browser does not support HTTPS, please use an up to date one to submit this form. Private information received will not be stored for any other purpose and is immediately forwarded to our physicians' mailbox.

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Verification

1. Request Code

Please enter the verification code

3. Submit