Are you seeking a physician for a pregnancy?

Yes  No

Please phone 905-985-2895 ext 6220 and request a doctor to look after your care during pregnancy.

                            

First Name:         
Mandatory !                                 As shown on Health Card
                                 
Last Name:        
Mandatory !                                      As shown on Health Card
Address:               
Mandatory !
City:                      
Mandatory !
Postal Code:         
Invalid Postal Code.       NO SPACES
Health Card #:        Must be 10 digits.                        Please enter the first 10 digits            Version code Health Card # Required!

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Phone number where you can be reached during business hours:
 
 Phone # :                ( ) -  -  
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Email:        
                                             Required.