New Patient Registration

Please be advised that registration is available online only through our website. The current waiting time is 3-6 months. We will contact you once your application is accepted.

Patient Information

First Name

Last Name

Phone

Date of Birth

Health Card Number

Version Code

Patient Address

Street Address

Address Line 2

City

Province

ZIP / Postal Code

Preferred Pharmacy

Preferred Pharmacy Address

Message (Optional)

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