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

Hours and locations:

 

Tuesday and Thursday  7:00am -3:30pm

Appointments outside of regular office hours available by request

 

OMEGA Fertility Center

555 Southdale Road East, #107

London, Ontario

N6E 1A2

 

t: 519-685-5559

e: holly@drhollyg.com

www.omegafertility.ca

 

 

 

Please come prepared for your first visit to ensure efficient use of our time together. To do so, please complete (and if possible submit) your intake form prior to your visit, and bring along any current medications/natural products, as well as any pertinent diagnostic imaging or laboratory results. Thank you!

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We offer direct billing to 10 major insurers, covering 85% of privately insured Canadians. Ask us to submit your claim for you at your next visit.

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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