Request appointment

This contact form cannot be used for communication with your doctor and is only for appointment booking.

Please Note: The online appointment request form should not be completed if you require an urgent appointment, if you need an urgent appointment please contact us by phone at: 613-825-0544

First Name (required)

Last Name (required)

Email (required)

Phone (required)

Reason of the Visit (required)

Preferred Days and Times (Multiple options are required)
Mondays
9 am- 12 pm12 pm- 2 pm2 pm- 4 pm

Tuesdays
9 am- 12 pm12 pm- 2 pm2 pm- 4 pm

Wednesdays
9 am- 12 pm12 pm- 2 pm2 pm- 4 pm

Thursdays
9 am- 12 pm12 pm- 2 pm2 pm- 4 pm

TeleMedicine
6 pm- 8 pm

Details