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Booking an Appointment

If you would like to book an appointment, please fill out the form below.
Please note, if you need to cancel or reschedule an appointment, we ask
that you please call the office at 519-272-0441 or 1-800-574-2742.

If you would like to fill out forms in preparation for your visit to the clinic please select from the list below or visit our Forms page to download. These forms may also be obtained from our receptionist and completed at the time of your first visit. (Please allow 15 minutes prior to your initial visit to complete these forms).

Infant Feeding and Postnatal Clinic Form
Private Prenatal Registration Form
Prenatal Breastfeeding Assessment Form
Adult Clinic Form
Fee Schedule and Office Policy

Personal Information: *Indicates Required Field

*First Name:

*Last Name:

*Phone:

*E-mail:

*Please indicate your preferred method of contact

Phone Email

Please indicate preferred date(s) and we will contact you to confirm

(mm/dd/yyyy, mm/dd/yyyy, etc.)

Please indicate the reason for this referral and any additional information that might be helpful for us in booking your appointment.