Out of Province Patients

  • To aid in booking an out of province or international travel stay with DMC, please complete the following screening questions. Alternatively, you can call the clinic and provide this information directly. Inquiries for pricing may be addressed to the clinic.
  • Patient Name & Contact

  • Local Resident Name & Contact (if necessary)

  • Referring Clinic & Contact

  • This field is for validation purposes and should be left unchanged.