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Appointment form
To make an appointment, call
450-676-1931
or follow the procedure below.
To make an appointment on line:
Select the type of consultation you need
Choose the day and time that are convenient to you
Give us your complete contact information
Fill out the form to open a medical file if this is your first visit
We will call or e-mail you within 24 hours to confirm your appointment or offer you another date and time.
Make an Appointment
Appointment date:
January
February
March
April
Mai
June
July
August
September
October
November
December
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2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year:
Preferred time of day for appointment:
morning
afternoon
evening
Please confirm my appointment by:
email
(telephone) home
(telephone) home
Comments, questions?
Personnal information:
First name:
*
Last name:
*
Gender:
F
M
Age:
Adress:
*
City:
*
Postal code:
*
Home (telephone):
*
Work (telephone):
*
ext:
E-mail:
Thank you for taking the time filling in this form. We are looking forward meeting you on your next meeting.
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3000 Montée St-Hubert, St-Hubert (Quebec), Tel.: 450-676-1931,
info@santedentairerivesud.com
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