"*" indicates required fields

MM slash DD slash YYYY
Choose a clinic*
(some specialized exams are only available in some clinics and are directly done by the physician)
Drop files here or
Accepted file types: jpg, png, pdf, gif, jpeg, Max. file size: 20 MB, Max. files: 3.
    (Must be a clear picture or scan)
    This field is for validation purposes and should be left unchanged.
    By phone

    Feel free to contact us Phone:

    514 470-0105
    By E-mail
    By Fax