We’ll go through four short sections.

Patient Information l Primary Concern l Insurance Details l Schedule a Call

Book an appointment with us via our online application or via

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Patient Information

In this section, we’ll gather basic information to create your medical profile. These details will also help us begin our conversation about you and your care needs.

This appointment request is for:
Please tell us your gender.
Have you previously received care at POLYCLINIQUE FARAH?

Next, tell us your Primary Concern
We’ll ask for a description of the medical concern that’s prompting your request.

You’ll also have a chance to let us know about any additional concerns.


Now we’d like to ask about your Insurance Details

If you have insurance, this is where you can enter that information and let us know.

If you don’t have insurance, don’t worry. We’ll answer all of your questions on our call.

Do you have health insurance?
Is your appointment related to workers’ compensation or a liability claim?
Choose a time
Choose a time
Choose a time

Your Signature