New Patient Registration

Complete this form if you currently do not have a family doctor.

Completing this form does not guarantee becoming a patient at Mediflex Clinic.

Please allow our office 3-4 weeks to process the completed form. Once processed, we will contact patients directly. Do not call our office for an update; do not call our office for registration. Patients already attached to another family doctor will not be contacted.

* Indicates required question

First name only

Phone number

Your healthcare province

Last 4 digits of your health number

Your city

Year of birth

Your sex at birth

Male Female Other

Name of your last doctor

Name and location of your preferred Pharmacy