GynOvie | Book an appointment

BOOK AN APPOINTMENT

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WHAT IS YOUR SITUATION*

I am a patient

I am a healthcare professional or a secretary in a clinic

I am a pharmacist

I am a representative for a pharmaceutical company

YOU ARE A PATIENT*

Obstetrics : Pregnant

Pregnancy follow-up : You already had your first appointment

You wish to cancel an appointment already booked at our clinic

You would like to leave a message for your doctor or ask him/her a question

I AM PREGNANT*

New pregnancy : you wish to book your first pregnancy appointment

Pregnancy follow-up: You've already had your first pregnancy appointment with one of our obstetrician-gynecologists, but you need further assistance.

GYNECOLOGY*

You have already been seen by a gynecologist at our clinic

You do not have a file at the clinic, but a doctor has sent you a referral for a gynecological consultation.

ORIGIN OF THE REQUEST FOR CONSULTATION*

The referral is from a family doctor

The referral is from a medical specialist

PATIENT FORM - APPOINTMENT CANCELLATION

Please note : any appointment not cancelled within the previous 48 business hours will incur a $40 fee which must be paid in cash before any other appointment can be booked.
Please note that your request will be processed within 2 business days.

Full name*

Date of birth*

DD slash MM slash YYYY

Phone number*

E-mail address*

Reason for cancellation (20 words)*

Would you like to book another appointment at the clinic ? If so, a new appointment request will be sent to you via e-mail.

PATIENT FORM - QUESTION OR MESSAGE FOR THE DOCTOR

Complete this section only if you do not need to be assessed by your doctor. Please make an appointment if you wish to be assessed by your gynecologist.
Gynecologists' schedules are split between hospital activities (operating days, 24-hour on-call duty) and outpatient clinics (colposcopy and ultrasound clinics, Gynovie). Your doctor doesn't come to Gynovie every day. It may therefore take several business days before we can answer your question or forward your message to your doctor.
Please note that an appointment is necessary if you develop new symptoms or if your condition does not improve. For emergencies, please go to the nearest emergency room, or visit a walk-in clinic. Please note that we do not provide acute care at the clinic, nor do we have a walk-in clinic.

Your message will be processed within 7 business days.

Full name*

Date of birth*

DD slash MM slash YYYY

Telephone number*

E-mail address*

Please ask your question or leave your message here (40 words)*

FORM FOR HEALTHCARE PROFESSIONALS

Your request will be processed within three business days.

Full name*

Affiliation / Clinic*

Phone number*

Fax number

E-mail address*

Request: 100-word text*

FORM FOR PHARMACISTS

Please fax your question or prescription refill request to 450-859-0011.
For all other questions, please fill out the form below. Your request will be processed within three business days.

Full name*

Pharmacy name*

Phone number*

Fax number

Gynecologist concerned by your request*

Request : 100-word text*

REPRESENTATIVE FORM

Your request will be processed within seven business days.

Full name*

Affiliation / Company*

Phone number*

Fax number

Email address*

Request : 100-word text*

PREGNANCY FOLLOW-UP

If you are 20 weeks pregnant or more and are experiencing vaginal bleeding, contractions, abdominal pain, fluid loss, decreased fetal movements or any other worrisome symptoms, please contact the Centre Mère-Enfant at Suroît Hospital at 450-371-9920, ext. 2146. If you are less than 20 weeks pregnant, please go to the nearest emergency room. Please note that we do not provide acute care at the clinic, nor do we have a walk-in clinic.

Please note that your request will be processed within three business days.

To help us process your request, please take a few minutes to complete our questionnaire. Please specify the purpose of your request so that we can serve you better.

Last name*

First name*

Date of birth*

DD slash MM slash YYYY

Phone number*

E-mail address*

Reason for your request (100 words)*

NEW PATIENT - FAMILY MD

Your family doctor must forward the consultation referral to the Centre de Répartition des Demandes de Services (CRDS). This is the access point set up by the Quebec Ministry of Health and Social Services to help patients who need a first appointment with a specialist.
Your consultation referral is prioritized by the CRDS, based on information provided by your family doctor. The CRDS team will make the appointment and contact you.
Our clinic is subject to the same CRDS requirements and regulations as other specialist clinics. We have no control over the prioritization of requests or wait times. The granting of appointments is beyond our control. Please contact your family physician if your health status changes while you are on the waitlist.

NEW PREGNANCY

All our gynecologists are affiliated with the Suroît Hospital in Salaberry-de-Valleyfield. Please note that if you choose to be looked after at our clinic, your delivery will take place at the Suroît Hospital.

Please note that your request will be processed within three business days.

To simplify the process, please take a few minutes to complete our questionnaire.

Health insurance number*

Expiry date on your health insurance card*

Date of birth*

DD slash MM slash YYYY

Last name*

First name*

Your mother’s name and maiden name*

Your full address*

Your telephone number*

Your e-mail address*

Your father's first and last name*

Your family doctor's first and last name*

Your pharmacy's name and address*

Your spouse's first and last name*

Your spouse's date of birth*

DD slash MM slash YYYY

Your spouse's telephone number*

First day of your last period*

DD slash MM slash YYYY

How many pregnancies have you had in the past ?*

Number of vaginal deliveries

Number of caesarean deliveries

Number of miscarriages

Number of ectopic pregnancies

New pregnancy

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Number of vaginal deliveries*

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Number of caesarean deliveries*

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Number of miscarriages*

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Number of ectopic pregnancies*

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Have you ever been treated by a gynecologist at the Gynovie clinic? If so, which one ?*

Do you suffer from a chronic illness ?*

Heart disease

Pulmonary embolism or thrombophlebitis

Type 1 or 2 diabetes

High blood pressure

Other, please specify (20 words)

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Specification

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Have you ever had a pregnancy-related complication ?*

Premature delivery

Severe growth delay

Pre-eclampsia or HELLP syndrome

Ectopic pregnancy

Recurrent miscarriage

Other, please specify (20 words)

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Specifications

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If you have a special request, please mention it here

GYNECOLOGICAL FOLLOW-UP

If you are experiencing heavy bleeding (change of protection every hour for two hours in a row), acute abdominal pain, fever or any other worrisome symptom requiring immediate attention, please go to the nearest emergency room, or consult a walk-in clinic. Please note that we do not provide acute care at the clinic, nor do we have a walk-in clinic.

Please note that your request will be processed within two business days.

To help us process your request, please take a few minutes to complete our questionnaire.

Last name*

First name*

Date of birth*

DD slash MM slash YYYY

Telephone number*

E-mail address*

Reason for request*

Post-operative appointment

Postpartum appointment

Abnormal menstruation

Post-menopausal bleeding

Menopause symptoms

Pessary maintenance

Contraception

Your gynecologist follows you for a vulvar pathology and you want to make a follow-up appointment

Fertility

Other, please specify

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Name of the gynecologist who operated on you*

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Date of surgery*

DD slash MM slash YYYY

Hidden

Type of surgery*

Hidden

Specification

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Your due date*

DD slash MM slash YYYY

Hidden

Delivery type*

Hidden

With the installation of an IUD*

Hidden

With the installation of a Nexplanon contraceptive implant*

Hidden

Abnormal menstruation*

Hidden

Post-menopausal bleeding*

Hidden

Menopause symptoms*

Hot flashes

Vaginal dryness

Other, please specify

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Specification

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Pessary maintenance*

Routine follow-up

Your pessary has fallen out or doesn't fit properly

You are bleeding

You think you have an infection

Other, please specify

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Specification

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Contraception*

Installtion of an IUD

Changing an IUD

Nexplanon implant installation

Changing or removing a Nexplanon implant

You would like to discuss your contraceptive options

You would like a follow-up appointment to discuss your current contraception

You are experiencing side effects and would like to discuss them with your gynecologist, please specify

Other, please specify

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Specification

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Specification

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Your gynecologist follows you for a vulvar pathology and you want to make a follow-up appointment*

Lichen sclerosus follow-up

Vaginitis follow-up

Other, please specify

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Specification

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Fertility*

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Other, please specify

NEW PATIENT - SPECIALIZED MD

This section applies to you if your referral has been made by a specialist and not by a family doctor. Here are some examples of specialists: gynecologists from another clinic, emergency physicians, urologists, internists, general surgeons, oncologists, etc.
The specialist must fax your referral to the Gynovie clinic (450-859-0011). The consultation referral will be evaluated and prioritized by one of the clinic's gynecologists. Please note that we receive a high volume of requests for consultations. Wait times vary depending on the reason for the consultation. Please contact your family doctor or referring physician if your health status changes while you are on the waitlist.
We will contact you by e-mail to arrange an appointment. Please note that you will not receive any calls to book or confirm appointments. All communication will be via e-mail.

Clinic Rules*

The gynecologists at the GynOvie clinic are affiliated with the Hôpital régional du Suroît in Valleyfield. Therefore, your delivery or surgery will take place at the Suroît Hospital.

You may be accompanied by only one adult aged 18 or over during your medical visit. To avoid overcrowding in the waiting room, your accompanying adult will follow you into the examination room during your appointment.

Please note that all treatments offered at the clinic are covered by the RAMQ. You are required to bring proof of health insurance coverage to EACH of your medical visits (valid health insurance card or proof of insurance provided by the Régie). Without proof of insurability, your appointment may be postponed.

It is important to confirm your appointment via the clinic's portal to avoid it being cancelled. Due to the high number of no-shows and despite the required e-mail confirmation, a $40 fee (cash) will be charged for appointments missed or cancelled within 48 business hours. The fee must be paid to the clinic before any other appointment is booked.

Please arrive at the clinic 10 minutes before your appointment time for triage and be available for the doctor at your appointment time. If you arrive 15 minutes late for your appointment, your gynecologist may not be able to see you and your appointment may be cancelled.

If this is a telephone consultation, the doctor will contact you. The appointment time is approximate. The number on your call display may be confidential, unknown or private.

The clinic is currently experiencing a major staff shortage. In order to provide you with quality service, we encourage communication via the Clinic Portal and our website.

I have read the clinic rules and I accept the conditions.

Clinic rules*

I have read the clinic rules and accept the conditions.

Clinic rules*

I have read the clinic rules and accept the conditions.

BOOK AN APPOINTMENT

BOOK AN APPOINTMENT

PATIENT FORM - APPOINTMENT CANCELLATION

PATIENT FORM - QUESTION OR MESSAGE FOR THE DOCTOR

FORM FOR HEALTHCARE PROFESSIONALS

FORM FOR PHARMACISTS

REPRESENTATIVE FORM

PREGNANCY FOLLOW-UP

NEW PATIENT - FAMILY MD

NEW PREGNANCY

GYNECOLOGICAL FOLLOW-UP

NEW PATIENT - SPECIALIZED MD

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