To register for a Family Doctor fill out this form and press send at the bottom of this page. First Name*Last Name*Email Address*Mobile Number*Home NumberDate of Birth*Gender*OHIP Health Card Number & Version CodeAddress*Address Line 2City*Postal Code*Province*HealthSmart Pharmasave (the pharmacy next door to our office) works collaboratively with our doctor's office to offer high quality care in an efficient and convenient way. If you do not already use HealthSmart Pharmasave, would you like to transfer your prescriptions to them?*Please selectYesNoI already use HealthSmart PharmasaveMy current prescriptions are at...*Phone Number*By pressing send, I consent to HealthSmart Medical contacting me via email, text or phone to complete a medical questionaire and book appointment with our family doctor.SendThis field should be left blank