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call us (905) 574-3000

New Patient Intake

(online form)

In Person Appointment

(online booking)

Virtual Appointment

(coming soon)

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Our Clinic
Our Clinic

Both of our lovely doctors are now accepting new patients, throughout all ages groups including children, everyone in the family are welcomed!
Our Doctors

Dr. Ayman Soliman

Dr. Meriam Basta
New Patient?

Want to register as one of our patients? You can easily fill out our new patient intake form including schedule appointments online!

New Patient
Intake Form
(online form)

In Person Appointment

Already an existing patient? Good news, you can now quickly book an in person appointment by filling out our booking online form!

Book In Person Appointment
(online form)

Virtual Appointment

Stay tuned for our virtual appointment booking system coming soon & have leisure to see our doctors all remotely — virtually!

Book Virtual Appointment
(coming soon)
Patient Forms
Contact

New Patient Intake

Please fill out this form

First Name *

Last Name *

Date of Birth *

Gender *

Address *

City *

Province *

Postal *

Phone Number *

Email Address *

Health Card Number *

Version *

Marital Status

Marital Status *

Emergency Contact Information

Emergency Contact Name *

Relationship *

Emergency Contact Phone *

Step 2 of 2 - Medical Information

Reason for today's visit *

Do you have a primary care provider (family doctor)?

Medical History

Current Medications (include dosages) *

Known Allergies *

Current Medical Conditions

Previous Surgeries or Hospitalizations

Family Medical History

Lifestyle Information

Do you smoke or use tobacco products? *

Never smoked

Former smoker

Current smoker

How often do you consume alcohol? *

Never

Occasionally (1-2 drinks per week)

Moderately (3-7 drinks per week)

More than 7 drinks per week