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Open 12:00pm ET / 11:00am CT and 8pm ET / 7pm CT - 7 Days a Week
Register for a virtual appointment here
Register for a virtual appointment here
Open 12:00pm ET / 11:00am CT and 8pm ET / 7pm CT - 7 Days a Week
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Book your virtual appointment
Click here if you are a returning patient
Returning Patient
Do you identify as Indigenous?
Yes
No
Opt Out Of The Video Call For This Visit?
Yes
No
Please provide reason for opting out
Select Reason
Weak Signal from Provider
Worried About Data Charges
No Privacy
Appointment Does Not Require Video
Not Comfortable with Technology
Other
First Name
Last Name
Preferred Name (Optional)
Gender
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Gender identity (optional)
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Other
Does not wish to disclose
Pronouns (optional)
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He/Him
Date of Birth
Age
Blood Type
Select a blood type
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Blood group B
Blood group O
Unknown
Email
Phone Number
Address
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Province
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Do you have a regular family doctor?
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No
If yes
Health Card Number
History
Medical Problems
Yes
No
If yes
Medications
Yes
No
If yes
allergies
Yes
No
If yes
Preferred Pharmacy
Yes
No
If yes
Have you contacted your family doctor?
Yes
No
If yes
Referred by 811?
Yes
No
Reason for visit
Respiratory Illness
Yes
No
Fever 38 or Greater
Yes
No
Shortness of Breath or Chest Discomfort
Yes
No
Abdominal Pain
Yes
No
Vomiting
Yes
No
Urinary Tract Infection
Yes
No
Rash
Yes
No
Wound Infection
Yes
No
Trauma or Injury
Yes
No
Earache
Yes
No
Prescription Refill
Yes
No
Sick Note
Yes
No
I don't have a regular family doctor or NP, but I have a general question about my health
Yes
No
If you answered yes to any of the questions above, please describe
Main reason for medical visit request today
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