Scheduling an

Appointment

SCHEDULING AN APPOINTMENT


Fill out this form and we will contact you as soon as possible.
TELL US YOUR AVAILABILITY

Adresse-Address

Ville-City

Code postal-Postal Code

Téléphone-Phone Number

Date du rendez-vous-Date of appointment

Heure-Hour


Êtes-vous un client actuel de la clinique?-Are you a current client of the clinic?
OUI-YESNON-NO

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