Contact

First name*

Last name*

Phone*

E-mail*

Date of Birth*

Request Exam*

Choose a clinic*

Langelier

Pointe-aux-trembles

Any

(some specialized exams are only available in some clinics and are directly done by the physician)

Where have you heard of us ?*

RAMQ # - If you don't have a RAMQ number, enter 0 here (exam fees apply)*

Card expiration month*

Card expiration year*

Upload your prescription*

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)

Phone

This field is for validation purposes and should be left unchanged.

Please Call Us: 514 470-0105

Feel free to contact us Phone:

514 470-0105

CORONAVIRUS (COVID-19)