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?
Are you a returning patient?
Is your dependent a returning patient?
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.Format: +1 (000) 000-0000.
Address

Street Address

Street Address Line 2

CityProvince

Postal Code

Caregiver/Guardian Information
What is your name?

First NameLast Name
Pronouns
Please select "Other" to provide your preferred pronouns
Please enter your preferred pronouns
Date of birth

MonthDayYear
Date
Email address
example@example.com
Phone number
Please enter your phone number
Please enter a valid phone number.Format: +1 (000) 000-0000.
Address
Please enter your 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?
Does your dependent have a current/valid BC Health Card Number?
Expiration date

MonthDayYear
Date

Is this a new concern or a follow-up appointment?
Would you like us to try and match you with the last Doctor who saw you if he/she is available?
Would you like us to try and match your dependent with the last Doctor who saw your dependent if he/she is available?

Patient Information