Dr. Pillay walk in clinic

We are currently experiencing exceptionally high volumes in British Columbia and wait time may be longer than usual.

We apologize for this and will endeavor to get back to you to schedule an appointment as soon as possible.
Pediatric Appointment Request Form

Please note: This service is only available for patients under the age of 18. Submissions for patients over the age of 18 will be rejected.
See a Doctor 100% Covered By Your BC Health Card

All your information is kept strictly confidential and 100% secure. For life-threatening emergencies call 911. If you are suffering an acute mental health crisis call 1-833-456-4566.
Is this appointment for you or for your dependent?*

This appointment is for myselfThis appointment is for my dependent
Are you a returning patient?*

YesNo
Is your dependent a returning patient?*

YesNo
Patient Information
Patient name*

First NameLast Name
Pronouns
Please select "Other" to provide the patient's preferred pronouns
Please enter the preferred pronouns
Date of birth*

MonthDayYear
Date
Sex assigned at birth*
Gender identity
Please select "Other" to provide the patient's preferred gender identity
Please enter the preferred gender identity
Email address*
example@example.com
Phone number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

Placeholder Email
BC Health Card Number

This allows us to offer your appointment for free. If you don't have this handy you can provide it before your appointment.
Do you have a current/valid BC Health Card Number?*

YesNo
Does your dependent have a current/valid BC Health Card Number?*

YesNo
Expiration date

MonthDayYear
Date

Is this a new concern or a follow-up appointment?*

New concernFollow-up appointment
Would you like us to try and match you with the last Doctor who saw you if he/she is available?*

YesNo
Would you like us to try and match your dependent with the last Doctor who saw your dependent if he/she is available?*

YesNo

Patient Information