Booking a COVID-19 Appointment

  • Fill out the information below, or call:
    1-855-414-2255.

    *Phone lines are open Mon-Fri 9AM-8PM, Sat: 9AM-1PM, Sun: Closed.

    *For appointments booked using this form, we do not schedule same-day appointments. Once our staff receive your details, they will contact you to confirm your appointment time.

    Please note: Electronic message transmission cannot be guaranteed to be secure or error-free, as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain viruses. If you prefer, please call our booking line at 1-855-414-2255 with any information containing your personal health information, as the integrity and security of this message cannot be guaranteed on the Internet.

    *If you need urgent medical care, please head to your nearest emergency room, or dial 911.

  • Format: Last Name, First Name
  • The Phone Number must be able to receive incoming calls
  • The Health Card Number Must Include the Version Code For UHIP Patients, email your UHIP card to waterloowalkin@gmail.com
  • Please be advised that not ALL reasons for visit can be treated over the phone. Therefore, under certain circumstances, the patient will be sent to a local clinic. For any concerns, please call 1-855-414-2255 for more information
  • Please List any drug allergies. If no allergies, please state “NONE” in the field.
  • Please Provide a List of Medications that you are currently taking. If no, please state “NONE” as your answer
  • Please Include Pharmacy Name, Address, Phone and Fax Number (Not required for patients who are requesting a COVID-19 assessment or testing)
  • If you do not have a family physician, type 'N/A'.
  • Only required for patients who are requesting a COVID-19 assessment or testing.
  • BY SUBMITTING THIS MEDICAL INTAKE FORM, I AM ACKNOWLEDGING THAT ALL THE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. IN ADDITION, BY SIGNING THIS FORM, I CONSENT TO RECEIVING A CALL FROM THE PHYSICIAN TO PROVIDE MEDICAL ADVICE OVER THE PHONE.

COVID-19 Testing Appointment
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