Appointment Form

Book an Appointment

Please fill out the information below.
Initial Consultation Agreement Date*

MonthDayYear
This Agreement is made between
RCIC

GURDARSHAN BATTH (R710519)
AND "CLIENT"
Client Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Please select an appointment date*
Purpose of the Visit or Consultation?*
In - Person, for 30 Mins Slot = $50Virtual, for 30 mins Slot = $50
What language do you Prefer during Consultation?*
Select Payment Method*
NOTE:- Credit Card Payments are subject to extra 3% Service charges. To Avoid, make payments via e-transfer.
Address for In - Person Consultations

9300 Goreway Drive, Unit 212, Brampton, ON, Canada.

Total*

Initial Consultation

In Person / 30Mins

$50.00CAD Quantity

Telephonic / Virtual Consultation

Initial / 30 Mins

$50.00CAD Quantity

Subtotal

$0.00CAD

Tax

$0.00CAD

Total

$0.00CAD

Please remit E-transfer payments by using info@sgncanada.ca and upload Screen Shot of the confirmation.
Payment Screen Shot (E- Transfer)*

Cancelof
Terms and Conditions

1) Client is required to provide a minimum of 24 hours cancellation notice by calling RCIC's office in order to receive a full refund.

2) Cancellations made less than 24 hours time frame are subject to a late fees of 30% deduction from the refund. This fees is intended to compensate for the time that was reserved for the client and can not be filled by another client at such a short notice.

3) Appointments can be rescheduled with a valid medical /emegency Reason.

4) No refunds or reschedules for late or NO show Cleints.
Signature*

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Book an Appointment