Appointment request

Complete this form and click "Send"
Fields with a * are required

Name* :

Phone* :

Email :



1/ Preferred day(s):

(Several possible choices)
Monday
Tuesday
Wednesday
Thursday
Friday


Morning (7:30 am - 12:00 pm)
Afternoon (12:00 pm - 5:00 pm)

(514) 931-0801

monday to friday from 7:30 am to 5:00 pm



2/ Reason for appointment:

Nursing care (vaccination, travel health...)

Gynaecologist

Cardiologist

Laboratory and medical assessment

Nutritionist
         Immigration exams
         Other reason

3/ Message:

(Optionally specify the reason for this appointment,
the number of people accompanying you, etc.)



4/ How did you hear about the CMIPQ ?

How did you hear about the CMIPQ ? :     Specify :

Protection of personal data
Most of the information contained on the website www.cmipq.com are freely available without entering personal data.
However, in some cases, the user must provide personal data. In this case the data are treated according to the law on the protection of privacy with regard to the usage of these data. In this regard, the CMIPQ specifically agrees that the use of the processed data is limited exclusively to the objective pursued.
The CMIPQ agrees to keep strictly confidential and not disclose, sell or disclose to third parties, by any means whatsoever, the information transmitted to it.