Patient Zone

Post-Treatment Care at Home

Appointment form

To make an appointment, call 514-397-9653 or follow the procedure below:>

To make an appointment on line :

We will call or e-mail you within 24 hours to confirm your appointment or offer you another date and time.

Make an Appointment
Appointment date:
Year : 
Preferred time of day for appointment : 
Please confirm my appointment by :
e-mail (telephone) home (telephone) work
Comments, questions?

Personnal information
First name :*
Last name :*
Gender :F M   Age :
Address :*  City :*   Postal code :* 
Home (telephone) :*
Work (telephone) :*  Ext : 
E-mail : 

 

Thank you for taking the time filling in this form. We are looking forward meeting you on your next meeting.