Appointment Request

Please contact our office by phone (780-963-4626) or complete the appointment request form below. One of our front desk administrators will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment. Please note, appointments cancelled or rescheduled less than 48 hours in advance may be subject to a $100 cancellation fee. This includes no-shows. 

*Items in bold are required.
Are you a current patient?

Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

Office Location

  • Stony Plain
  • 3919 49 Avenue
  • Suite 109
  • Stony Plain, Alberta
  • T7Z 2J7
  • Map & Directions
  • Call: 780-963-4626