Baby Circumcision Registration

Please complete the registration form below for baby circumcision.

We will call you back to confirm your appointment and answer your questions.

Thanks for booking with us.

  • Child Information

  • Date Format: DD slash MM slash YYYY
  • Parent Information

  • Medical History

  • If the mother is taking any form of blood thinner (Dalteparin, ASA) you will need to call the office to speak with our doctor prior to your appointment.
  • Referral Contacts - Optional

  • Circumcision Consent

    You must consent to the following:
  • This field is for validation purposes and should be left unchanged.

Our Mississauga clinic has moved to 77 Queensway West, Suite 310.

Please wear a face mask when you come for your appointment. It is necessary by law.

Please do not arrive late for your appointment. For infection control reasons we limit the number of persons in clinic at any given time. If you are more than 10 minutes late, the clinic reserves the right to reschedule your appointment.