Register

Please complete the following form to the best of your ability and click Submit. Completing all of the fields will reduce processing time for your registration and help you avoid being placed on the waiting list.
  • CONTACT INFORMATION

  • (Last name as shown on Health Card only)
  • (if we need to re-schedule your appointment) Please advise if your number is long distance.
  • MEDICAL INFORMATION

  • eg. Oct. 10, 2018
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