Dr. Holly Giannatselis | Make an appointment | Dr. Holly Giannatselis
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appointments

 

Please be advised that consultations are currently being held virtually.

Visits are expected to be offered in-person beginning Fall 2023.

 

Hours and Location:

Monday 10:00am – 3:00pm

Tuesday 9:30am -8:00pm

Wednesday 10:00am-3:00pm

Thursday 9:30am – 8:00pm

Friday 10:00am – 3:00pm

Saturday CLOSED

Sunday CLOSED

 

OMEGA Fertility Center

373 Commissioners Road West

London, Ontario

N6J 1Y4

 

t: 519-685-5559

e: holly@drhollyg.com

www.omegafertility.ca

 

 

 

Please complete your intake forms prior to your visit. Copies will be emailed once your booking has been confirmed. If you are not able to complete the electronic forms PDF versions are available on this page.

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Direct billing is available to over 30 major insurers.

forms

Dr. Holly Giannatselis PDF
Form 1

Information Consent

Dr. Holly Giannatselis PDF
Form 4

Pediatric Intake Form

Dr. Holly Giannatselis PDF
Form 7

Pain Questionnaire

Dr. Holly Giannatselis PDF
Form 2

Informed Consent

Dr. Holly Giannatselis PDF
Form 5

Medications & Supplements

Dr. Holly Giannatselis PDF
Form 8

Benefit Assignment Form

Dr. Holly Giannatselis PDF
Form 3

Intake Form

Dr. Holly Giannatselis PDF
Form 6

Review of Systems

Dr. Holly Giannatselis PDF
Form 9

Electronic Transmission Authorization and Consent Form

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