Doctor Request Form - Medicentres

Did you know that many of our physicians have family practices? If you or anyone in your family needs a family doctor, we have you covered.

Just fill out the form below and one of our staff will contact you.

By providing us your contact information you consent to Medicentres contacting you directly.

First Name

Last Name

Phone Number

Email Address

Please check this email - we will use it to confirm your request. We do not send sensitive information via email and we will call you if your request needs to be discussed in detail

Where are you located?

Please select if you have a preferred location:

Calgary

Winnipeg

Edmonton

Ontario