Online Appointment Account Registration

Please fill in the details below in order to create your booking appointment. Fiels marked with a * are mandatory.

First Name

Last Name

Date Of Birth (dd/mm/yyyy). (If you are under 16, you can make an appointment under one of the parents/guardians, and MUST be accompanied by that parent/guardian)

Cell/Mobile or Home Phone Number

Address Line 1 (Building No. & Street)

Apartment No. (if applicable)

City

Province

Postal Code

OHIP Card Number

Name displayed on OHIP card

OHIP Card expiry date

Preferred Language

Email Address*

Confirm Email Address*

Password

Confirm Password

Calling centre code (Leave blank otherwise)

Do you consent to sharing your email address and SMS number Yes No

Do you have a smart phone? Yes No

* Please ensure your email address is valid as it will be used for validation, password resets and other Online Appointments related communication. By submitting my email address and SMS, I consent to receive email and SMS communication from Hôpital Montfort related to my COVID-19 Assessment and associated care. While Hôpital Montfort will use encrypted email to communicate, I understand that email is not a secure method of communication and therefore Hôpital Montfort cannot guarantee the security of messages sent by this method between myself and the hospital. I understand that information contained in email messages may be personal health information which may be used in decisions about my treatment or care and if used for this purpose, will be retained on my health record. If I wish to withdraw my consent to communicate by email, I may do so at any time, but I must do so in writing and ensure all relevant correspondents receive a copy of my withdrawal notice. By providing my email address I declare that I have read this information, understand it and wish to proceed with email communications as outlined above.