Telemed MD - See a Doctor, Wherever You Are.

Answer the following questions so the doctor can better help you.

Why are you booking a virtual visit? *

What's your reason for seeing a psychiatrist? *

What's your reason for seeing a gynecologist? *

What's your reason for seeing a dermatologist? *

What's your reason for seeing a pediatrician? *

What's your reason for seeing a general internist? *

What's your reason for seeing a nephrologist? *

What's your reason for seeing a cannabis consultant? *

Answer the following questions so the doctor can better help you.

What is the name of the medication you need? *

Why do you need this medication? *

Are you currently on this medication? *

Yes No

If yes, how long have you been taking it? *

Not Applicable

Answer the following questions so the doctor can better help you.

What kind of test are you looking for? *

Describe your reason for booking in detail. *

Select your preferred LifeLabs location so we know where to send the lab requisition.

Search by typing in lab name and its street or address

Telephone:

Looking for LifeLabs near you

Preferred Lab

Lab Name *

Lab Address *

City *

Province *

Postal Code *

Phone Number

Fax Number

Answer the following questions so the doctor can better help you.

For which specialist do you need a referral? *

Answer the following questions so the doctor can better help you.

What's your reason for seeing a psychiatrist? *

What's your reason for seeing a gynecologist? *

What's your reason for seeing a dermatologist? *

What's your reason for seeing a pediatrician? *

What's your reason for seeing a general internist? *

What's your reason for seeing a nephrologist? *

What's your reason for seeing a cannabis consultant? *

Answer the following questions so the doctor can better help you.

Please describe what you are experiencing. *

How long has this been an issue? *

Not Applicable

What is the frequency, intensity, and duration? *

Not Applicable

What makes it better or worse? *

Not Applicable

Attach photo(s) of the area of concern *

Not Applicable

Include pictures with different angles and details to clearly show the area of concern. Please ensure they are not blurry and have good lighting. You can upload a maximum of 3 photos that are at least 300px wide or tall (we recommend at least 1000px).

Add Photo

skinmole.jpg

The doctor will call you within your chosen time frame.

Select the day *

Select the time *

Morning

Afternoon

Evening

Provide your information so a doctor can contact you.

Personal Info

Your Full Name *

Date of Birth *

Sex *

Contact Info

Cell Number *

Home Number

Email *

Address *

City *

Province *

Postal Code *

Please select your health coverage.

Card Number

Issue

Expiry

Non-Ontario Health Card

Province

Card Number

Issue

Upload Only One of the Following

Students

Please upload your University Health Insurance Plan (UHIP) card.

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Visitors

Please upload your Interim Federal Health Program (IFHP) card.

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If you do not have a UHIP or IFHP, you may skip to the next page, however there will be costs associated with each service. Learn more.

Provide some additional registration to save time!

Family Doctor (Optional)

Doctor's Name

Phone Number

Fax Number

Address

City

Province *

Emergency Contact

First Name *

Last Name *

Relationship *

Cell Number *

Email *

Home Number

Provide some additional registration to save time

Current/Past Medications *

Not Applicable

Major Hospitalizations, Illnesses, Surgical Procedures *

Not Applicable

Allergies *

Not Applicable

Select your preferred pharmacy using one of the following options so we know where to send your prescriptions.

Search by typing in your pharmacy name and its street or address

Telephone:

Looking for pharmacies near you

Preferred Pharmacy

Pharmacy Name *

Pharmacy Address *

City *

Province *

Postal Code *

Phone Number

Fax Number

Review the following information to ensure they are correct.

Scheduled Appointment Edit

Appointment Date:

Friday, Oct 30, 2020

Appontment Time:

9 - 10am

Reason for Visit Edit

Service Type:

General Consultation

Test Type:

STI

Specialist

Psychiatry

Issue

Mental Health

Reason for booking:

It's itchy down there

Description of symptoms:

I keep coughing and I have a sore throat so I can't sing karaoke

How long has this been an issue?

3 months

What is the frequency, intensity, and duration?

Every 5 min, loudly

What makes it better or worse?

Drinking bbt makes it worse. Drinking hot tea makes it better.

Name of medication needed:

Codein

Why do you need this medication?

Too much pain from heartbreak

Currently on this medication?

No

How long have you been taking it?

N/A

Preferred Lab Edit

Lab Name:

LifeLabs Medical Services

Address:

I keep coughing and I have a sore throat so I can't sing karaoke

Telephone:

(647) 766-7666

Fax Number:

(647) 766-7666

Personal Info Edit

Full Name:

Janet L. Kim

Home:

(h) 905 - 235 - 7890

Birthday:

Dec 23, 1990

Cell:

(c) 647 - 868 - 4567

Gender:

Female

Email:

[email protected]

Address:

1234 Terrace Dr.

Toronto ON M2R 3N4

Health Coverage Edit

Card Type:

Ontario Health Card

Attached File:

1234567890 XY

Card Number:

1234567890 XY

Issue Date:

Aug 4, 2018

Expiry Date:

Aug 4, 2022

Family Doctor Edit

Doctor's Name:

Sylvia Chen

Cell:

1234567890

Address:

1234 Terrace Dr.

Toronto ON M2R 3N4

Fax:

1234567890

Not Entered

Emergency Contact Edit

Full Name:

Sylvia Chen

Relationship:

Mother

Cell:

(c): 647-766-7666

Email:

[email protected]

Medical History Edit

Current Past Med:

General Consultation

Major Hospitalizations, Illness, Surgical Procedures:

I keep coughing and I have a sore throat so I can't sing karaoke

Allergies:

3 months

Preferred Pharmacy Edit

Pharmacy Name:

Shoppers Drug Mart

Address:

I keep coughing and I have a sore throat so I can't sing karaoke

Telephone:

(647) 766-7666

Fax Number:

(647) 766-7666

See a doctor,
wherever you are.

See a doctor,
wherever you are.

How It Works

Need to speak to a doctor virtually?

Book an Appointment

Speak to a Doctor

Finalize

Need to speak to a doctor in person?

Find a Clinic

Book an Appointment

Come In

Talk to a Specialist

Frequently Asked Questions

Our Partners

Contact Us

Non-Ontario Health Card

See a doctor, wherever you are.

See a doctor, wherever you are.

How It Works

Need to speak to a doctor virtually?

Book an Appointment

Speak to a Doctor

Finalize

Need to speak to a doctor in person?

Find a Clinic

Book an Appointment

Come In

Talk to a Specialist

Frequently Asked Questions

Our Partners

Contact Us

Non-Ontario Health Card

See a doctor,
wherever you are.

See a doctor,
wherever you are.