Request an Appointment

Last Name*
First Name*
Are you an existing patient?	Yes No
Date of Birth:	Month Day Year
Who would you like to see?*
	For a Sports Medicine Physician, Orthopaedic Surgeon or Pain Specialist, please see your family physician for a referral.
Injury*:
Contact Number*:
E-mail*:
Day Preference*:
Time Preference:
KOPI enforces a 24-hour cancellation policy for all missed appointments. A cancellation fee is applied as a missed appointment prevents other patients from scheduling appointments at that time.

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