Doctor Note Appointment and Information Form 🏥📝

Please fill out your details and appointment information to receive your doctor note promptly. For refund, we deduct $20 charges because of administration charges and payment gateway charges. Important: The date range must not exceed 7 days. Please mention the dates clearly, for example: January 1 to January 3, 2026.
Full Name

First NameLast Name
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

CityState / ProvincePostal / Zip Code
Date of Birth

MonthDayYear
Date
Reason for Doctor Note

0/150
Important: The date range must not exceed 7 days. Please mention the dates clearly, for example: January 1 to January 3, 2026.
Doctor note start date

MonthDayYear
Date
Doctor note end date

MonthDayYear
Date
Important Information
Doctor’s notes will be issued within 3 hours after your appointment. Please ensure all information provided is accurate for timely processing. Working hours: 9AM to 5PM.

Doctor Note Service

Request and receive your official doctor note after your appointment.

$45.00 CAD

Total

To schedule or reschedule your appointment, please call us at 587-442-4898 or email booking@telepluscare.com. We kindly ask that you avoid last-minute cancellations or rescheduling requests. Missed appointments or no-shows without prior notice may result in a $40–$60 fee before rebooking. Please inform us as early as possible if you need to cancel or reschedule, and help us respect our doctors’ time by attending your scheduled appointment.
Should be Empty: