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Medical Form for New Patients

You are a new patient?

You must first complete a questionnaire collecting all details related to your health status prior to your first appointment. In order to accelerate the process, we invite you to fill-in the following questionnaire at home :

1. Download Medical form (PDF) by clicking here

2. Fill it in

3. Print the questionnaire and bring it with you for your appointment
OR
  Send it to us as an attachment in an email at info@pichecotegilbert.com

In the event that you need to cancel your appointment, we ask that you notify us by phone or email at least 48 hours prior.