Appointment Request Form

Name: Our Freelton Office
Address: 835 Regional 97 Road, Freelton, ON, L8B 0Z4, CA
Telephone: 905-659-3937
Price range: $000 - $300

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

Complete the following form:

Please fill in the form below to setup an appointment.
Reason for Appointment
Please provide a reason for your appointment. Details are stored securely and not sent by email.
Preferred Date & Times*
Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
Patient Type*
- New patient
- Returning patient
Please let us know if you are a new or existing patient.
Name*
First Last
Phone*
Email*
Best Time to be Reached for Confirmation*

: HH

MM
Comments
Phone
This field is for validation purposes and should be left unchanged.

We are happy to announce that we will be reopening gradually starting on Monday, June 8.

Of course all emails and voice messages will be checked on a regular basis and you will be contacted as soon as possible.

Thank you for you cooperation.