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Patient Information

First name

Last name

Phone Number

REASON FOR MESSAGE *If none of the below are applicable, please phone the clinic.

***Prescription renewals requests are only accepted by fax from pharmacies. Please ask your pharmacy to fax us if you need a medication renewal.***

Non-Urgent Appointment Request

Please visit https://christieclinic.cortico.ca/book/ to book an appointment online.

Appointment Cancellation

Appointments cancelled with <24H notice will incur a fee of $40 for a regular appointment or $80 for a physical or counselling appointment.

Inquiring About Results

Please first visit https://www.thechristieclinic.ca/about-3 to see how you can view your results online. Please note that if you are requesting a copy of your results to be sent to you, this will incur a $10 administrative fee.

Insurance Form or Letter Request

Please note this service is not covered by OHIP. You may also be asked to book an appointment.

Non-Urgent Appointment Request

Please provide your REASON for booking the appointment & list your availability in as much detail as possible (ie. Monday AM, Wednesday PM) and we will get back to you with an appointment day/time.

Insurance Form or Letter Request

Please upload your form and include the deadline, above. Please fill out the demographics section of your form and sign if applicable BEFORE sending the form. Please note that we recommend planning at least 30 days in advance of deadlines but will try our best to fulfill more urgent requests. Please note, you may be asked to book an appointment to complete the form and so it it would be helpful to include your general availability above (ie. Monday AM, Wednesday PM).

Files

Add file

Please upload a file

Appointment Cancellation

Please list your physician, date and time of appointment. If you wish to reschedule, please list your general availability (ie. Monday AM, Wednesday PM)

Inquiring About Results

Please list the test (blood work, x-ray, ultrasound) and when/where it was performed. You will either be notified of results by phone, email, or will be booked in with your physician to review.

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