Request an Appointment

Complete the form below to request an appointment at Healthpoint. An appointment representative will contact you to book your appointment.

If you have a medical emergency, call 998.

All fields are required unless marked optional.

Requester Information

Who is this appointment for?

Patient Information

Please provide patient information as it appears on legal documents.

Have you previously received care at Healthpoint?

First Name:





P.O Box:

Primary phone:

Secondary phone:



Date of Birth:

Parent/Guardian name:

The name of a parent is required if
the patient is under the age of 16.

Does the patient need
an interpreter?

Patient Insurance Information

Does the patient have health insurance?

Insurance Name:

Medical Concern

What is the primary medical problem or diagnosis for the appointment request?

Important: After submission, please do not leave this form until you see the confirmation message.