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TO BOOK A CONSULTATION, CALL
Calgary: (403) 450-3759
Toronto: (905) 773-9675 or |
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E-mail us the completed form by
clicking submit |
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Name: |
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Date Of Birth: |
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Address: |
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| vCity: |
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State |
Country |
| vZip
Code: |
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| vPhone: |
(Home) |
(Office) |
| vFax
Number |
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| vE-mail: |
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| Preference
of time (check one answer) :
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AM PM |
| Preference
of day (check all possible days) :
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Mon
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*Someone from my
Clinic will contact you within 2-3 days
to confirm your appointment.
Thank you.
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