Book a
House Call Appointment
Step 1 of 5
20%
1. Have you used our service before?
Have you used our service before?
*
Yes
No
Fees start at $150 and vary depending on our nurses' and doctors' travel time. Private service, not covered by RAMQ.
2. Do you have any of the following medical conditions?
Do you have any of the following medical conditions?
*
Diabetes
High blood pressure
High cholesterol
Respiratory disease
Cognitive difficulty
Mental health issues
Require palliative care
Other
None of the above
In a few words, please tell us why you would like to see the doctor.
Reason for Appointment
*
4. Who is the medical house call for?
Who is the medical house call for?
*
Me
Someone else
Please provide your information for consent:
Name
*
First
Last
Phone
*
Relationship to the patient:
*
4. What is the address for the house call?
Please note that we only service the Montreal and surrounding areas
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
5. Lastly, please provide more information about the person requiring the medical house call.
Name
*
First
Last
Date of Birth:
*
Date Format: DD slash MM slash YYYY
RAMQ health card number (optional):
Phone Number:
*
Email:
*
