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Consultation Request

Complete the form below and a practitioner will follow up to schedule your virtual session. After submitting, proceed to payment to confirm your booking.

Before you submit

What happens after you submit

Your request is sent to the MCHUSA team. A practitioner will contact you to confirm your session time. To secure your booking, complete the initial consultation payment after submitting this form.

Medical records

With your consent, your practitioner can access your medical records through the DHN to support an accurate diagnosis and appropriate care. Consent is given at the time of your consultation, not through this form.

Available practitioners

  • Dr. Elizabeth Bhagwandass, General Practitioner
  • Michelle Jackman, Speech-Language Therapist & Audiologist
Consent note: Your practitioner may review your medical records only with your explicit consent, given at the time of consultation. Do not include sensitive health details in this form. Marked fields (*) are required.

After submitting, proceed to payment to confirm your initial consultation.