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 and North York clinics remain open for surgical procedures.

We continue to enforce strict infection control protocols.

Please wear a face mask when you come for your appointment.

Please do not arrive late for your appointment. For Covid prevention we limit the number of people in the clinic. If you are more than 10 minutes late, we reserve the right to reschedule your appointment.

Thanks for your help.