Pre-Booking Questionnaire

Please fill out this quick questionnaire to be directed to our online booking site.

If the patient's health card is expired or they do not have OHIP, please call us.

Child Phone Appointment (under 18)

Who is booking this appointment on behalf of the child patient?

I am the PARENT booking for the child patient with my name/email

I am the CHILD patient booking for myself with my name/email

CHILD Health Card

PARENT First Name

PARENT Last Name

Home Address

Preferred Pharmacy Address

Prescriptions cannot be emailed to patients due to safety protocol.

Reason for Appointment

Phone Number for the Paediatrician to contact you at

ATTENTION: Your booking is not complete until you schedule the appointment date/time on our booking site (clicking "Submit" will take you to our booking site where you must login and schedule the appointment)

I understand that on the booking site I must register an account with MY OWN info (name, email, health card, etc) even if booking for my child

Please check your spam folder for any missed emails from clinics@primacymedical.com and report them as "not spam."

Pre-Booking Questionnaire

Child Phone Appointment (under 18)

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