Online Doctor Appointment Form

Appointment Booking Form Halton Medix

Fill the form below and we will get back to you to confirm your appointment.
Please note our new hours for Burlington:

Mon-Fri 10:00 a.m. - 5:00 p.m. - Sat 10:00 a.m. - 2:00 p.m. Sun- Closed *** After hour care is available at our Milton location 5:00 - 8:00 p.m. for rostered patients of Dr. Sarwat Kamran, Dr. Manpreet Gill, Dr. Sadia.Rashid, Dr. Fiona Hu and Dr. Faeeza Javeed. Please call to confirm before arrival.
Please note our new hours for Milton:

Mon-Thurs 10:00 a.m. - 8:00 p.m. - Fri : 10:00 a.m. - 5:00 p.m. Sat - Closed - Sun 10:00 a.m. - 1:00 p.m. *** After hour care is available at our Milton location 5:00 - 8:00 p.m. for rostered patients of Dr. Sarwat Kamran, Dr. Manpreet Gill, Dr. Sadia.Rashid, Dr. Fiona Hu and Dr. Faeeza Javeed. Please call to confirm before arrival.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Date of Birth*

DayMonthYear
E-mail Address*
Have you been to our clinic before?*

YesNo
Reason for visit?*
Physician*
Appointment Location*

BurlingtonMilton
Please Note:

Staff will call you to confirm the availability of Doctor based on their schedule (Time and Location)
There is no guarantee of same day appointment.

This form is only an appointment request not a confirmed appointment. Until you receive a call back from us your appointment is not confirmed.
Appointment*
Disclaimer*

I undertand this appointment request is not confirm until I recieve a confirmation call or email from the staff.
Should be Empty:

Appointment Booking Form Halton Medix

Please note our new hours for Burlington:

Please note our new hours for Milton:

Please Note:

There is no guarantee of same day appointment.