Request an Appointment

To request an appointment, fill in this form. We will then contact you to confirm available appointment times. If this is urgent, please phone us instead of using this form.
Please select your patient type*
- New Patient
- Existing Patient
Appointment Location*
Choose a Doctor
Specialist in Hamilton*
Select the specialist who treats you.
Specialist*
Specialist*
Specialist*
Patient Details
Name*
First Last
Phone number*
Mobile number
Email
Date of birth*
Your Address*
Street Address Address Line 2 City ZIP / Postal Code
As you are a new patient, we will contact you and assign a specialist that best meets your needs. If you already have a preference as to which specialist you would like to see, please mention that here:
Reason for this appointment*
How long have you had this problem?
Past medical history*
Attach any additional information or photos (optional)
Max. file size: 8 MB.
Please send us any relevant attachments such as a photo or document.
Are you fully vaccinated against COVID-19?*
- Yes
- No
As a health care provider, we accept both vaccinated and unvaccinated patients. Knowing your vaccination status enables us to potentially take extra precautions if needed.
If you need an appointment urgently, please phone us instead of filling in this form.
Phone
This field is for validation purposes and should be left unchanged.

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