Request Appointment

CREDIT VALLEY HEALTH CENTER 905-828-0270

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Request an Appointment with one of our Doctors

* Indicates required field

Name *

First

Last

Date of Birth (dd/mm/yyyy) *

Health Card *

Version Code *

Phone Number *

Email *

Doctor *

Reason for Visit *

if you selected other, please describe the reason *

Is this an urgent matter? *

Urgent Non-Urgent

Staff will triage each request based on all information given. If you feel that it is an emergency, please go to the nearest Hospital Emergency Dept.

Symptoms (Check all that apply) *

N/A Fever Cough Respiratory Pain Rash/Skin issue Mental Health Other

Please further describe your symptoms *

How long have you been having these symptoms *

N/A 1 day or less 2-3 days 3-7 days 7+ days

Have you taken any medications to manage your symptoms? *

N/A Yes No

If yes, please list the medications you have taken *

Please note: You may receive a call/email from staff to go over your request OR a call directly from your doctor. This call may be from a blocked/unknown number. Our clinic will not be receiving calls after hours, on weekends or on holidays - so please make sure you do your best to answer our calls so we can manage your care in a timely fashion.

*

I Understand

I am available the following days of the week: *

I prefer a phone call from the doctor *

Any time Morning Afternoon Evening

Submit

Credit Valley Health Center
16-2555 Erin Centre Blvd
Mississauga ON, L5M 5H1
Phone: 905-828-0270
Fax: 905-828-0277

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Home
RX RENEWAL
Request Appointment
REGISTER
FHO After Hours
Speak to a Receptionist
Flu Vaccine Consent Form