Women's Health Consultation Request
Our experts are here to help improve your health! To request a consultation, please submit the form below:
(Note: The fee for a one hour consultation is $200 tax included)
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First Name *
Last Name *
Email *
Address *
Phone Number *
Date of Birth (DD/MM/YYYY) *
Health Card Number *
Primary Physician's Name *
Would you like an in-person or virtual consultation? (In-person appointments take place in-store only. We have a private consultation room at Brant Arts IDA Pharmacy located at 672 Brant St. Burlington) *
If you have a Brant Arts Practitioner of choice, please notify us at this time. (We will do our best to accommodate based on availability)
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We're so glad you're here and look forward to connecting with you. Please tell us, how did you hear about our Women's Health Program? *
Any notes/messages for us at this time?
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