Patient Intake Form

    3300 Highway 7, Suite 600-02
    Vaugh, On. L4K 4M3
    416 241 0099


    (Mr. Mrs. Ms. Dr.)

    What is 4 + 8 ?


    Please provide us with a minimum of 36 HOUR NOTICE for cancellations by phone or email. This will enable us to provide the vacant slot to the patients who require our services.

    Our policy regarding Cancellation: A cancellation fee equal to 100% of your charges applicable to the original time reserved specifically for you, unless you or your child is ill or there is an extenuating circumstance. A $50 fee is charged for last minute cancellations and FULL AMOUNT is charged for No-Show’s.

    Thank you for helping us to maintain a high level of services for all our clients.