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Located right in the centre of Smithville,
just south of the intersection of Hwy 20 and Griffin St. S.

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Home » Patient Forms » Appointment Request Form

Appointment Request Form

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.
  • Please provide a reason for your appointment. *Please do NOT send private information on this form.*
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
  • :
  • This field is for validation purposes and should be left unchanged.

Urgent or Private information should NOT be sent by email as it is not monitored after hours. Please call the office directly or, for emergency concerns after hours and stat holidays, go directly to an emergency department.