Use the form below to ask us about your Referral.

Type of Inquiry:*

Check Referral Status

Book Specialist Appointment

Request Security Code (online booking)

Cancel/Re-book Appointment

Patient First Name (As it appears on Health Card)*

Patient Last Name (As it appears on Health Card)*

Patient Private E-mail:*

Referring Physician Name (optional):

Did the Referring Doctor already sent (via fax/online) a referral to our facility?*
Yes     No

If yes, when was the referral sent to our facility?:
Choose the specialty clinic you were referred to: *

For any other Specialist/Specialty clinic, please specify:

I have read, understood and
agree to the Terms of Service. I understand that if this is a medical emergency, I will call 911 or go to nearest emergency department for immediate care.*