Ajax Harwood Clinic · Patient Access

How Can We Help You Today?

Tell us what's on your mind and we'll make sure the right person gets back to you. This takes about 2 minutes.

🚨  If this is a life-threatening emergency, call 911 now. Do not use this form.
1
Select Concern
2
A Few Questions
3
Your Details
Step 1 of 3
What brings you in today?

Select the option that best describes your concern. If you're not sure, choose the closest one — we'll sort out the details.

🩺
New symptom or health concern
Something new that needs to be assessed
💊
Prescription renewal
Medications that need to be refilled
🔬
Test results or specialist report
Lab work, imaging, or follow-up results
📋
Form or letter needed
Insurance, sick note, WSIB, driver's medical
🫀
Managing an ongoing condition
Diabetes, blood pressure, asthma, and more
🧠
Mental health support
Anxiety, sleep, stress, group sessions
✈️
Travel medicine
Vaccines, yellow fever, malaria prevention
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Something else
Tell us what's on your mind
← Back
Step 2 of 3
A few quick questions

This helps us prioritize your care correctly.

← Back
Step 3 of 3
Your Details

Almost done. We just need a way to reach you.

📞 We will call this number — please double-check it before submitting.