​

​

PLEASE NOTE:
 

Please be sure your paper requisition is fully completed with your NAME, HEALTH CARD NUMBER, DATE OF BIRTH and a VALID PHONE NUMBER; these fields are REQUIRED to be filled out on the requisition photo in addition to this online form.

Kindly ensure a clear image of the entire requisition is uploaded so we can process your request without delay.

If any patient information is missing, the document is unclear, or only a partial image of the requisition is provided, an appointment will NOT be scheduled.