Appointment form

To make an appointment, call 514-768-3368 or follow the procedure below :

To make an appointment on line :

  • Choose the day and time that are convenient to you
  • Give us your complete contact information
  • Fill out the form to open a medical file if this is your first visit

We will call or e-mail you within 24 hours to confirm your appointment or offer you another date and time.

Make an Appointment

Appointment date:
Year : 
Preferred time of day for appointment : 
Please confirm my appointment by :
e-mail (telephone) home (telephone) work
Comments, questions?

Personnal information

First name :*
Last name :*
Gender :M   Age :
Address :*  City :*   Postal code :* 
Home (telephone) :*
Work (telephone) :*  Ext : 
E-mail : 


Thank you for taking the time filling in this form. We are looking forward meeting you on your next meeting.

38 Place du Commerce, bureau 201, Ile des Soeurs (Verdun), Qc, H3E 1T8 • Tel : 514-768-3368 •