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Consultation Request - Mental Health Nurse Practitioner
By submitting this form, you authorize the Lacroix Private Medicine team to contact you to schedule a consultation. Please note that the person who will call you is not a healthcare professional and therefore cannot provide medical advice. The sole purpose of this form is to book an appointment.
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IMPORTANT: If you are in psychological distress and believe you need immediate help, call a relative, a friend, or 911 and explain your situation.

By submitting this form, I consent to the Lacroix network's use of my personal information.

For more details on the Lacroix network's personal information governance practices, please refer to the network's Personal Information Governance Policy and Privacy Policy here.