We Kidz Booking Book your visit online quickly and easily. Providing some background information will help process your appointment quickly and efficiently. *Please indicate the type of care: A Well Child Examination A Circumcision An Acute Illness Treatment An Immunization or Vaccine Newborn Care Name of Person Completing This Form:(Required) First Last Name of the child you are seeking care for:(Required) Your Child's Age:(Required) Your Preferred Email Address(Required) Your Phone(Required)Referral Source:(Required) Please briefly describe the nature of your visit:(Required)CircumcisionsName of Person Completing This Form:(Required) First Last Name of the child you are scheduling a circumcision for:(Required) Your Child's Age:(Required) Your Phone(Required)Reservation and Payment InformationCircumcisions are not covered by OHIP, and require that we set up your payment profile.Please note that your reservation is confirmed once your payment profile is established. After submitting this form, please follow the link provided to set up a credit card payment profile with our clinic. This will be used to process payment for the procedure and any further health services not covered by OHIP. If you already have a payment profile on file with us, please check the box below to provide consent for us to charge this card for your appointment. Should you wish to pay via e-transfer, please send this to hello@wekidz.ca along with the submission of this form in order to book your appointment.Payment Preference:(Required) I already have a payment profile set up with We Kidz Pediatrics, and authorize you to charge my card for this procedure I will set up a new payment profile (link on next page) I will pay by e-transfer (details on next page) I understand my reservation is only confirmed after payment is arranged.(Required) I agree Disclaimer IMPORTANT - Please read the following DISCLAIMER: This form is NOT to be utilized for medical emergencies. If faced with a medical emergency involving your child, immediately contact a pediatrician or trusted healthcare specialist, or DIAL 911. At no point should you engage in self-treatment or administer care to others based solely on what you've encountered on this website. It's crucial to always consult with Dr. Omar Afandi or another qualified pediatric healthcare provider in your area about any concerns or questions related to your child's health. Disregarding or postponing professional medical advice due to information gleaned from this website is strictly discouraged. I have read the above disclaimer(Required) Yes, I Agree Please double check your email and phone number above.(Required) Yes, I have checked.
