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Appointment form

To make an appointment, call 514-842-1124 or follow the procedure below.

To make an appointment on line:
  1. Select the type of consultation you need
  2. Choose the day and time that are convenient to you
  3. Give us your complete contact information
  4. Fill out the form to open a medical file if this is your first visit
We will call or e-mail you within 24 hours to confirm your appointment or offer you another date and time.

Make an Appointment

Appointment date: Year: 
Preferred time of day for appointment: 
Please confirm my appointment by:
email (telephone) home (telephone) home
Comments, questions?

Personnal information:

First name:*
Last name:*
Gender: M   Age: 
Adress:*  City:*   Postal code:* 
Home (telephone):*
Work (telephone):*  ext: 
E-mail:

Thank you for taking the time filling in this form. We are looking forward meeting you on your next meeting.



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1414 Drummond, suite 722, Montreal (Qc) H3G 1W1, Tel.: 514-842-1124, Fax: 514-842-6131 luclecomte@bellnet.ca

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