Send Us Your Message

If you have any questions or would like to request a specific treatment program for a patient, please do not hesitate to contact us filling out the following contact form and a representative from Global Healt Quest will contact you within 24 hrs.

Phone: 647.206.4879
Toll Free: 1.888.542.1054
E-mail: info@globalheathquest.ca

Contact Information Form

    Patient Information Form







    Do you smoke?

    Drink Cola/Coffee?

    Drink Alcohol?


    Are you currently under medical care for any reason?


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    Women Only

    Do you smoke?

    Are your periods regular?




    Past Psychiatric/Mental Health Care



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    List All Operations


















    List all times you have been admitted to a hospital
    overnight (except
    for childbirth)



















    Please check if any relative (parents, siblings,
    grandparents,
    children) have had any of the conditions listed below

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    Please list the date and results (if known) of your last

    X-Ray



    EKG



    Blood Count





    I

    verify that the above information is accurate based on my
    knowledge and am requesting a quotation for treatment.


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    Location Canada

    Brampton
    201 County Court Boulevard, Suite 303
    Brampton, ON L6W 4L2

     
    Toronto
    129 Yorkville Avenue, Suite 300 Toronto, ON M5R 1C4
     
    Mississauga
    55 City Centre Drive, Suite 400 Mississauga, ON L5B 1M3

    Location Cuba

    Brampton
    201 County Court Boulevard, Suite 303
    Brampton, ON L6W 4L2

     
    Toronto
    129 Yorkville Avenue, Suite 300 Toronto, ON M5R 1C4
     
    Mississauga
    55 City Centre Drive, Suite 400 Mississauga, ON L5B 1M3