{{ message }}
New Concern
Follow-up
Type of Appointment
Regular
Medication review
ICBC
WCB
Injection
Name
First and Last Name
Email address
you may also email us at
info@buenomedicalclinic.com
with this email to confirm your identity if this is your first time using this form
Mobile Number
Phone/SMS contact information
Your Daytime Availability
office hours are 9am-4:00pm - Your daytime availability (preferred days and time) e.g. Mondays and Tuesdays in the morning
Preferred Pharamacy
Where you would like us to fax or send prescriptions
Submit Booking Request