Online Booking - Emergency Visit
Thank you for completing this form. Once click submit at the bottom, you will be directed to a page where you can book and confirm your appointment. 

Our office does not accept direct payment from insurance companies. Payment will be due at the time of the visit. We will file all insurance forms on your behalf and your insurance company will reimburse you.

PERSONAL DETAILS
Your personal details. Please review them and make any necessary adjustments.
The following questions apply to your child and anyone in your household. If you answer "YES" to any of the following questions please contact our practice at 905-303-6010 for further instructions.