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Appointment Request

To request an appointment with your Family Physician, please complete the form below.

If you have a new or worsening cough, sore throat, shortness of breath, runny nose/sneezing, nasal congestion, hoarse voice or difficulty swallowing please CALL THE OFFICE.

Same Day or Next Day Appointments are Not available online. 

Please call 519-470-3030 for an Urgent Request.

"We are aware that Hotmail and Outlook email is filtering our replies, please use an alternative email if possible"  ALL RESPONSES WILL BE MADE THROUGH EMAIL ONLY 

Cancellation & Appointment Bookings are monitored, Monday to Friday 8am-4pm.

Should you not receive a response within 2 business days, please look in your junk mail folder and add us to your Contact list. If the message is not in your junk mail, please call the office at 519-470-3030.

In an emergency don't call or email the clinic. Call 911 immediately.

Date of Birth:
Confirm email:
Phone Number:
Preferred day/time:
Photo - to help in handling your request (max 10Mb):
Please state the nature of your request:

In using this on-line registration service you accept that you are submitting your name, e-mail, name of your doctor and other details through this website. This information will be used for the sole purpose of tracking and administrating your request.

While we take all reasonable precautions to safeguard your data, you acknowledge that the transmission of data through the Internet and the use of computing devices represent a risk beyond the control of the Family Health Team. We suggest you assume that all data transmitted through this service may be intercepted and analysed by third-parties, and that you only submit information on this understanding.