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

Locate Us

9855 Austin Rd #147 - Lougheed Town Centre
Burnaby BC V3J 1N4
Phone: 604-420-2115
Fax: 604-420-2177
Emergency Contact:

In case of emergency, please phone our office at the number listed above and follow the instructions.

162-164 East 13th Street
North Vancouver BC V7L 2L5
Phone: (604) 986-9566 or (604) 984-8666
Fax: (604) 986-9574