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450 659-9011
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Services and expertise

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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November 25, 2016

A brand new website

Your clinic is proud to present its brand new website, now mobile friendly.

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November 25, 2016

Digital file tool

According to our sustainable development and innovation vision, it is with enthusiasm that we have set up a new procedure for opening new patient files.

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450 659-9011

215 Boul Jean-Leman office 204
Candiac, QC J5R 6Z8

info@gremilletpodiatres.com

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450 659-9011

215 Boul Jean-Leman office 204
Candiac, QC J5R 6Z8

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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

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About the clinic

Services and expertise

News

A brand new website

Digital file tool

Subscribe to our newsletter

450 659-9011

215 Boul Jean-Leman office 204 Candiac, QC J5R 6Z8

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

Thank you!

Sorry!

215 Boul Jean-Leman office 204
Candiac, QC J5R 6Z8

Opening
file