Please complete the following Telemedicine Form

Section 1:  Patient Demographic Information

as it appears on your health card

as it appears on your health card

If you are not a current patient with Acton Medical continue answering the rest of section 1; current patients can move onto section 2.

Are you currently suffering from a medical condition, illness, or injury?

Your Signature

Have you been hospitalized in the last 12 months?

COVID-19 Information 

Acton Medical and Urgent Care is NOT a testing site for COVID-19. 


Patients who are concerned that they have been exposed to COVID-19 or are having symptoms of COVID-19 are encouraged to get assessed and tested at an Assessment Centre.

The following link provides an up-to-date list of COVID-19 symptoms:


Please use the following link for COVID-19 self assessment, testing locations and checking for your COVID-19 test results:


For Questions about the COVID 19 Vaccine, please see the following link:  

 If you have a medical emergency please call 911.


If you have any medical questions/concerns you can call 

Telehealth Ontario at 1-866-797-0000.