Medical Evaluation Appointment Form

Thank you for your interest in booking an appointment with TriMedical. All information provided is strictly confidential.

Please complete the form below. Our patient coordinator will reach out to you to schedule your appointment and confirm your booking.

First Name

Last Name

Please indicate reason for appointment

Marine Medical

Drivers Medical

Railway Medical

Aviation Medical

Firefighter Medical

Law Enforcement Medical

Other, please indicate below

Additional Information, if applicable

Phone Number

Email Address

#102 - 12565 88th Avenue
Surrey, BC, V3W 3J7
Canada

Toll-free: (236) 862-2126