Dr. Carol Rui Dou Waiting List
Dr. Dou's family practice is accepting new patients starting in February 2024 on a rolling basis at City Square Medical Centre at 550 West Broadway St, Vancouver. If you would like to be added onto the waiting list, please fill out this form. The clinic will directly contact you when space becomes available. At that point, you will be asked to fill out a more detailed intake form that you need to bring to your first appointment. Please do not call or drop by the clinic regarding the status of the waiting list. If the form is open, that means we are still accepting patients onto the waiting list. 

By filling out this form, you are consenting to the following information being transmitted to Dr. Dou and City Square Medical Centre through secure email. You also are consenting to us contacting you by email to schedule an appointment.

If you are uncomfortable with an online waiting list form, you are welcome to print this out, fill it out manually, and submit this in person to 307-550 West Broadway, Vancouver.

Please note, filling out this form adds you to the waitlist, but is not a guarantee that you will accepted into the clinic.


Email *
Email *
First Name *
Last Name *
Birth date
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DD
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YYYY
City or town of residence *
Do you have valid MSP coverage in BC? *
Do you have a family doctor or nurse practitioner currently?  *
Do you have a copy of your past medical records that can be made available to us upon acceptance as a patient?  *
Do you have any specific medical concerns that need to be addressed in a timely fashion? If yes, please elaborate.
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Please list names of current specialists (if any) that are involved in your care
Any other information that you would like Dr. Dou to be aware of? Eg. if you are registering anyone else in the family.
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