Make An Appointment – Evans Sunrise Medical Centre

Other Information

Note: If you are experiencing a medical emergency, please dial 911 to contact local emergency response personnel.
Please be assured that this online appointment request is a secured and confidential area and that information entered and submitted is confidential.

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Patient Gender*

Male

Female

Have you Previously been a patient? *

Yes

If Yes, Clinic Number:

Patient First Name *

Patient Last Name *

Parent or Guardian Name (if patient is under 18)

Patient Address *

Postal Code

City/Town *

Phone

Mobile Phone

Fax

Recent Tests or X-rays (include dates)

Additional Information to the appointment*

Appointment type*

General Examination

Speciality

Appointment Date Requested*

Send a copy to your email

JobsÂ |Â Book an AppointmentÂ |Â Suggestion BoxÂ |Â Contact Us