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Request an appointment
You can request an appointment at any of our Clinics using our online scheduling request form.  Please obtain your Manitoba Health ID Card; you will need the six digit registration number (MHSC) as well as the nine digit Personal Health ID Number (PHIN) to register your request.

Please remember this is a request not a booking; our clinic staff will review your information and get back to you to confirm the appointment.  If the appointment time or physician you request using this system is not available we will suggest a new appointment.

You will be contacted within 24 hours of your request. This feature currently does not support the Doctor House Calls program; for more information please see our special programs section (link) or call the Doctor House Calls line at 204.582.2362.

 
 
Which Clinic:  
Doctors/Physician Name:     
Have you been to this clinic before?
When would you like an appointment: Date?     
Which hours you prefer? Morning Afternoons Evenings Does Not Matter
If above Date & Time is not suitable then which days of week would you Prefer? Mon Tues Wed Thurs Fri Sat Sun 
First Name (as printed on valid Health card)
 
Last Name (as printed on valid Health card)
 
Birth Date:

(mm/dd/yy)
    

Sex:
 
Home & Mailing Address:
 
MHSC Number (6 digits) ?
PHIN Number (9 digits) ?
Phone contact number(s)
 (phone-1)  
 
 (phone-2)
Email address (optional)  

Reason for Visit/Consultation (problem/aliment)
 
    
Data security on this request form is managed using a GoDaddy SSL Certificate.  Your information will be transmitted to our server using up to 256-bit encryption, enabling the highest level of browser security available for the World Wide Web.  For more information on data security and SSL please see the Privacy Policy section of this website.

-Four Rivers Medical Clinic

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