Request an Appointment

Nantais Family Chiropractic
1614 Lesperance unit #3
Tecumseh, Ontario N8N 1Y3
519-979-2273
info@nantaischiro.com
*Indicates a Required Field

Please view our office hours and then fill in the following form to request an appointment. You will receive a confirmation call to verify, before any appointment is scheduled.

*First Name
*Last Name
*Phone

Format XXX-XXX-XXXX
*Email Address


Date and Hour for Requested Appointment

*Select Hour *AM/PM

*Please tell us if you are a current patient, or are requesting to become a new patient.
I am a current patient at your office
I am looking to make an appointment to become a new patient


Optional Short Comments or Message



NOTE: You do not have a scheduled appointment until we can call you and verify this appointment request.

               

Monday
7am to 10am   3pm to 6pm
Tuesday
 3pm to 6pm
Wednesday
 7am to 10am
Thursday
 7am to 10am   3pm to 6pm