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The Clinic offers all professional services, by qualified podiatrists using the most advanced technologies and methods to evaluate your symptoms and aches, and make a precise diagnosis.

Biomechanical evaluation
Plantar orthotics
Podopediatrics
Sports podiatry
Minor surgery
Podiatric treatments
Postural imaging
Digital radiography
Laser treatment
Podiatry ultrasound
Skin surgery in podiatric medecine

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450 659-9011

9, boul. Montcalm Nord, bureau 300,
Candiac Qc J5R 3L5

info@gremilletpodiatres.com

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450 659-9011

9 Montcalm Boulevard North, Suite 300
Candiac Qc J5R 3L5

Write us Find us

Business hours

Monday8AM to 8PM
Tuesday8AM to 8PM
Wednesday8AM to 5PM
Thursday8AM to 5PM
Friday8AM to 2PM

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First consultation

Date of initial visit

Reason of consultation *

Personnel medical information

First name *

Name *

Address *

City *

Province *

Postal code *

Phone #1 *

Phone #2

E-mail *

Occupation

Birth date *

Age *

Height (inch or cm) *

Weight (pound or kilos) *

Shoe size *

Emergency contact

Emergency phone

Children (18 years old and under)

Name of parent 1

Name of parent 2

Various

Where did you hear about our clinic?

Website Family, friends Facebook Canada 411 Le Reflet Newspaper Yellow pages Other

Have you ever consulted a podiatrist?

Yes No

Does you insurance cover podiatric care ?

Yes No

Past medical history

Family doctor

Last visit

Have you ever been diagnosed in the past or presently?

Diabetes

Arthritis

Articular prosthesis

High pressure

Low pressure

Cardiac problems

Cancer

Skin problems

Do you smoke?

Sexually transmitted diseases (STD)

DJD Asthma Epilepsy Hepatitis A, B, C or Cirroh Anemia Are you and hard drug user? Digestive Problems Frequent headache or migraine Stomach Ulsers Are you HIV+ or been diagnosed AID Anxiety Visual problems Kidney problems Hearing Problems Are you pregnant? Thyroid problems Prolonged bleeding

Do you take any medicine? Which?

Have you ever had a reaction to

Iodine Aspirin Penicillin Codeine Sulfides (SULFA) Local Anasthesia

Food and/or allergies

Other medicine

COVID-19 survey (also applies in a deconfinement situation)

Do you have fever ?

Yes No

Do you have a cough ?

Yes No

Do you have breathing difficulties ?

Yes No

Do you have a loss of smell and / or taste ?

Yes No

Have you tested positive for COVID-19 or are you waiting for a screening result ?

Yes No

Have you been in contact with a confirmed or probable case of COVID-19 ?

Yes No

If you are a healthcare professional

Have you been in close contact with a confirmed or probable case of COVID-19 WITH and / or WITHOUT personal protective equipment ?

Yes No

I confirm all the provided information is true and correct

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^*Please note that a $45 fee will apply for any cancellation without a 24 hours notice.

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About the clinic

Services and expertise

Services and expertise

The Clinic offers all professional services, by qualified podiatrists using the most advanced technologies and methods to evaluate your symptoms and aches, and make a precise diagnosis.

Subscribe to our newsletter

450 659-9011

9 Montcalm Boulevard North, Suite 300 Candiac Qc J5R 3L5

Business hours

Opening file

First consultation

Personnel medical information

Children (18 years old and under)

Various

Past medical history

Have you ever had a reaction to

COVID-19 survey (also applies in a deconfinement situation)

If you are a healthcare professional

Thank you!

Sorry!

9 Montcalm Boulevard North, Suite 300
Candiac Qc J5R 3L5

Opening
file