Physician Portal

Intake

Patient Health Questionaire

Name(Required)
MM slash DD slash YYYY
Preferred name/pronouns (if applicable):
Address(Required)
Consent
Medications (prescription and non-prescription)(Required)
Allergies(Required)
How did you hear about us?(Required)

Address

Suite 301 - 272 Charlotte Street, Peterborough, Ontario, Canada

Phone Number

+1 705-876-9003

Fax Number

+1 705-874-5410

Office Hours

Monday | 9:00 AM - 3:00 PM
Tuesday | 9:00 AM - 3:00 PM
Wednesday | 9:00 AM - 3:00 PM
Thursday | 9:00 AM - 3:00 PM
Friday | 9:00 AM - 12:00 PM
(summer hours)

*Subject to change with holidays, etc.

Follow us for contests and to checkout some of our happy clients

Instagram Facebook
Disclaimer
The information contained on this website is intender for a Canadian audience noted. Information regarding cosmetic services is provided by the American Society of Plastic Surgeons as stock and accordingly prices are in American dollars. This website is designed to provide general information. Results from treatment and services are never guaranteed and may vary. Risk are inherent to any surgical or non surgical treatment and should be discussed in detail with your provider.
Copyright © 2023 - Kawartha Plastic Surgery - All Rights Reserved.
Scroll to Top