Contact us

Make an appointment

Fill out the appointment request form below. 

A member of our team will contact you as soon as possible for an initial telephone evaluation.

*Your consultation request will only be sent to members of our team and will be treated confidentially. No information will be sent to your primary care physician or included in your medical record without your prior consent.

While filling out this online request is the best way to reach us, you can also contact one of our clinics during our business hours.

Our mission at Memory Clinic is to participate in medical advances in Alzheimer’s disease. Initial assessments allow us to determine your potential eligibility to participate in one of our research programs. Unfortunately, some people are not eligible to participate.

Here are some examples of conditions that will not allow us to proceed with your application: 

– Inability to consent;

– Inability to read and write in English or French;

– Inability to undergo an MRI (metallic implant, pacemaker, severe claustrophobia…);

– Unstable or severe mental health diagnosis.

Is the appointment request for you?

    Please complete the form below.

    Gender :

    Date of birth :

    Address :

    Your primary care physician :

    Your pharmacy :

    Which clinic would you like to be contacted by?

    Would you be willing to answer a short questionnaire in preparation for our first call?

    1) Do you or people around you have concerns about your memory?

    For how long, and what are they?

    2) Do your memory difficulties interfere with your daily activities or functioning?

    Check all applicable fields :

    3) Have you ever received one or more of the following diagnoses :

    4) How did you hear about us?

      Information of the person completing the application: (we will ask for the patient’s information below)

      Which clinic would you like to be contacted by?

      Information of the person for whom the application is being completed :

      Gender :

      Date of birth :

      Address :

      Primary care physician :

      Pharmacy :

      Would you be willing to answer a short questionnaire in preparation for our first call?

      1) Do you or people around you have concerns about their memory?

      For how long, and what are they?

      2) Do these memory difficulties interfere with their daily activities or functioning?

      Check all applicable fields:

      3) Has the individual ever received one or more of the following diagnoses :

      4) How did you hear about us?

      Ottawa

      Ottawa Memory Clinic

      Monday to Thursday 8:30 a.m. to 4:30 p.m. – Friday 8:30 a.m. to 12 p.m.

      1600 Carling Avenue, Suite 100, Ottawa, ON K1Z 1G3

      (613) 702-1000 FAX (613) 702-1001

      Soon – 2024