I have a family doctor at the clinic

Here’s how to schedule an appointment

How to schedule an appointment

Family doctors of the Clinique médicale Le Sentier are using the advanced access model for appointments. To schedule an appointment with your family doctor, please complete the following form or contact a member of the secretariat by telephone at 450-690-3690 Extension 5.

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TO LEARN MORE ABOUT ADVANCED ACCESS

Click on the following button to find out more about advanced access
Advanced Access

.

You must be registered as a patient of a family doctor at La Clinique médicale Le Sentier to use this form.

Appointment request
Fill out this form to request an appointment. The secretary will contact you by email or telephone to confirm the date and time of your appointment.
* If you use this form, please do not call us to make an appointment.
1 Your informations
2 Medical questions

Name*
As it appears on your card of the Régie de l'Assurance Maladie du Québec (RAMQ)
First Name Last Name
Date of birth*
Age
How would you like to receive your appointment confirmation?*
By Email
By Phone
Phone*
Phone number to reach you
Extension
Extension number (if needed)
Name of your family doctor
To make an appointment, you must be a patient of this doctor.
Person who is to be contacted
The name of the person who is to be contacted (if different from the patient)
Do you have a valid RAMQ card?*
yes
no
Email*
Please enter your email Please confirm your email

If you do not provide a valid RAMQ card number, you will need to pay for the consultation.

RAMQ card number*
No space please (ex. GUAL71012115)
Expiration date*
No space please (format AAAAMM)

According to you, your appointment is:
Urgent : you wish to see the doctor within 24 to 48 hours.
Semi-Urgent : you wish to see the doctor within 5 days
Not urgent : vous wish to see the doctor within 2 to 4 weeks
*Note: As an indication only, our appointments are given according to the availability of doctors.
For any emergency, go to the hospital or dial 9-1-1.
When do you prefer your appointment
Morning
Afternoon
For information only. We may not be able to respect your preference.
Please indicate the days of the week you are usually available
Monday
Tueday
Wednesday
Thursday
Friday
Please tell us why you need an appointment (a few words)*
Pregnancy
I am pregnant
How many weeks*
Menstruation
I am late
Have you done a pregnancy test? Otherwise it is recommended to make one.
Temperature
I have fever
What is your temperature
Unit
Pain
I feel pain
Pain level
Veuillez évaluer votre douleur sur une échelle de 0 à 10;
0 étant aucune douleur, 5 étant une douleur modérée, 10 étant une douleur insoutenable.
Where is the pain located*
For Example: head, knee, neck
Loss of consciousness or convulsions
Please check if it applies
I had a loss of consciousness or convulsions
Trauma
Please check if it applies
Major blow to the head or face, fall, trauma or aggression
Medicines
I am taking one of the following medicines: Coumadin (Warfarin), Xarelto (Rivaroxaban), Pradax (Dabigatran), Eliquis (Apixaban)
Terms
Show the Terms
By clicking on the "send" button you accept the following conditions:

You must be a patient registered with a doctor at Le Sentier Medical Clinic to use this form.

This form is an appointment request. Staff must confirm the date and time of your appointment.

The staff reserves the right not to grant you an appointment.

The staff reserves the right to grant you an appointment with a doctor other than your family doctor.

Our appointments are given according to the availability of doctors.

We can not guarantee that you will be seen at the desired time.

You write your information on a secure site. In the exceptional case of disclosure, we can not be held responsible.

Terms approval*
I accept the Terms
Phone
This field is for validation purposes and should be left unchanged.

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Here's how to reach us

(450) 690-3690

88 chemin de la Rabastalière W - office 201, St-Bruno-de-Montarville, Qc, J3V 1Y8

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