the Medi Labs Clinic BOOK AN APPOINTMENT Our nurses are available 24 hours a day / 7 days a week Montreal: 514-646-5227 Estern Townships: 873-339-5227 info@medilabs.ca If you do not receive confirmation that your form has been sent, please fill it in again.Name*Date of Birth ( JJ / MM / AA )* Date Format: DD slash MM slash YYYY Email* Phone*Address* Address Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal code Address where nurse will meet you Address Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal code Medicare card #*What day(s) would you like your appointment? **MondayTuesdayWednesdayThursdayFridaySaturdaySundayWhat time would you like your appointment?* : HH MM AM PM Prescribing Doctor's Name*Doctor's fax #*Please scan your prescription and send it to us*CommentsConfirmation* I understand that all information provided is accurate. PhoneThis field is for validation purposes and should be left unchanged.