COVID-19 Update: Appointments will take place virtually*

*Except for IUD and Nexplanon Insertions and Removals

Request an Appointment

Please complete the following form or call 519-743-9360 to request an appointment.

Due to the high volume of messages we receive, please expect a 1 – 2 day delay in receiving a response to your message.

Please do not send urgent requests or sensitive medical information through this form.

Your Name *

First

Last

What Name Would You Like Us to Call You? *

This can be the same or different from the name you listed above.

Email *

Confirm Email

Can we contact you by email? *

Phone Number *

Can we leave a voicemail message for you? *

Date of Birth

Gender

Pronouns

eg. she/her, he/him, they/them, ze/zir

First Day of Last Period (if applicable)

Medical Appointment You Would Like To Book

Do you need an interpreter for your appointment? SHORE Centre's services are provided in English.

What language would you like interpretation for?

If you have requested an appointment for IUD or Nexplanon Insertion

I have a prescription already
I need a prescription

To confirm booking an appointment, we will need to collect some more information from you. Would you prefer to:

Complete an intake form online
Be contacted by phone

Schedule Pick Up at Office For

Anything else you would like us to know?

SHORE Centre

Phone: 519-743-9360
Fax: 519-743-6710

Address
130-235 King St. E.
Kitchener, ON N2G 4N5