Request Appointment

New Client appointment Request

This form is for new clients. If you are already a client you can call the clinic to book at 519-719-1782, use online booking, or add yourself to the existing client waitlist.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Preferred Therapist *

Choose One *

Only contact me when appointments become available with my requested physiotherapist I would like to see the first available physiotherapist that can treat my issue

Primary reason for your assessment *

Please tell us a little more about your condition *

If you were referred by someone please let us know here: *

Submit