GENERAL INQUIRES Ottawa-ProvisRudd Endoscopy

First Name

Last Name

Email

Phone Number

Reason for Request:

I would like to receive a call back

I would like to book a procedure appointment (referral sent from doctor)

I did not receive the prep instructions

I need to confirm appointment date/time

I have questions about my medications

I would like to request my medical records/images (patients only)

Please provide details of the request:

Best day for call back

Best time for call back

Morning

Afternoon

Evening

Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use.

GENERAL INQUIRES Ottawa

If you would like a call back please continue this form or if you would like a response by email please click on submit