Request an Appointment

Complete the form below to request an appointment. Our staff will contact you to confirm your appointment day and time. New patients are welcome to use this form.

If you need to cancel or change your appointment, please call us: 250 479-2099.

Are you a current patient? *

yes

no

Full Name *

Email *

Phone Number *

Best time to call *

Describe the nature of your appointment request (Exam, Emergency, etc.) *

Preferred day(s) of the week for an appointment *

Preferred time(s) for an appointment *

Morning

Noon

Afternoon

Any

Which Dr. would you like to see? *

Dr. Jerry Jacob

Dr. Brittney Leeming

Dr. Roland Tupas-Singh

Any

Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

Office Hours

New Patients