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Appointment Request Form

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
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  • This field is for validation purposes and should be left unchanged.
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Unfortunately, as of Tuesday, October 4th at 8:00AM, we remain without power and remain closed. If power is restored, we will open and resume appointments immediately. We will call if reopening happens midday.

Anyone who has missed an appointment since Sept. 26 will be contacted to arrange rescheduling.

Our phone system also requires power and that is why you have not be able to get through on our phone line.

Anyone with an emergency should report to the QEH.

We look forward to returning to service you at the soonest possible time.