Patients may register upto 15 minutes before arriving at our clinic.

Have you been here before?

Yes
No

First Name (As it appears on Health Card)*

Last Name (As it appears on Health Card)*

Date of Birth (YYYY-MM-DD)*

Reason for the visit: *
(Please choose one of the following that best describes your symptom.)



I have read, understood and
agree to the Terms of Service. I understand that if this is a medical emergency, I will call 911 or go to nearest emergency department for immediate care.*