Name *

First Name

Last Name

Phone *

(###)

###

####

Have you seen us before? *

Yes

No

Are you looking for custom foot orthotics? *

Yes

No

Maybe, I'm not sure

Date / Location Requested *

Dr. Randhawa works Wednesdays-Saturdays from 9:30am-3pm. On Wednesday's she is at our Kingsway location and the other days she is at our Fraser street location. Please select the days you are willing to come to - making note of which location she works at - and we will offer you the first available appointment. You can select as many options as you wish

Wednesday's at KINGSWAY

Thursday's at FRASER street

Friday's at FRASER street

Saturday's at FRASER Street

Virtual Video Consult (via Zoom)

Telehealth phone call/consult

Preferred appointment time *

Morning (9:30am-12pm)

Afternoon (12pm-3pm