NEW PATIENT FORMS
Please open and print the new patient form below, fill it in completely, and sign where indicated. You may bring this form with you to your first appointment or return it to us in advance. Our office address is 210 Milton Street, Nanaimo and our fax number is 250-753-7771.
You will need Adobe Reader to open the new patient form. You can download a free copy from http://get.adobe.com/reader/ . Be sure to choose the right operating system for your computer (Windows Vista or Mac OSx for example) then click on the download button and follow the directions.
If you have Adobe Reader, or once you've downloaded and installed it, you can click on either the image or text below to open the form. To get back to this page, just close the form.
PLEASE NOTE:
If you have extended coverage, check with your plan to see how much of the visit fee will be reimbursed to you. MSP no longer covers any portion of the fees unless you are receiving MSP Premium Assistance.