Open 24 Hours 905.953.1933
Patient History Questionnaire

Patient History Questionnaire


Please note:

  • You must download the form prior to completing it.  Please ensure you save the file as you complete the questions.  Once completed, save the final document and e-mail to
  • Completed forms must be received no later than 72hours prior to the appointment or rebooking may be required.
  • Forms may also be faxed or mailed if preferred.
    • Fax# 905.953.8845