Appointment Request Form Please complete the form below to setup an appointment. You will receive a message if submitted correctly.Preferred Doctor*Choose OneDr. Shaun MacInnisDr. Jessica PrendergastDr. Ashley ChiassonNo PreferenceReason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred Date & Times*Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.Patient Type*New patientReturning patientPlease let us know if you are a new or existing patient.Name* First Last Date of Birth*Phone*Email* Best Time to be Reached for Confirmation* : HH MM AM PM CommentsPhoneThis field is for validation purposes and should be left unchanged.