Serving Brantford, Paris and the surrounding communities.

Appointment Request Form

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If this is an emergency, do not contact us via email, please use our emergency contact information.

Complete the following form:


Location Required
Doctor Required
Reason for Appointment	Appointment requests are sent to your practitioner using regular email so please do not enter confidential information.
Preferred Dates & Times Required	Check our office hours
First Name Required
Last Name Required
Telephone Required
Email
Best Time to be Reached for Confirmation Required
Comments

130 Charing Cross Street
Brantford ON N3R 2J1
Phone: (519) 756-6173

Emergency Contact:
During business hours, please speak with one of our team members by calling or coming into our office so that we may assist you.

Outside of business hours, please go directly to the Emergency department at the nearest hospital.

Paris Location

139 Grand River St. North
Paris ON N3L 2M4
Phone: (519) 442-2411

Emergency Contact:
During business hours, please speak with one of our team members by calling or coming into our office so that we may assist you.

Outside of business hours, please go directly to the Emergency department at the nearest hospital.

Disclaimer

Appointment Request Form

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