Family Physician Waitlist

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Please complete this form if you wish to be put on a wait-list to join the practice of a family physician at Corktown Medical Centre. We anticipate adding a new physician to our group who will be accepting patients in the near future. We anticipate bookings to start in February 2021.

By completing this form, you are not registering with the clinic or with any individual physician; you are only being put on a list to be scheduled a "Meet & Greet" visit with a physician.

Please note that only after you and the doctor meet and agree to establishing the professional relationship, would you formally be added to their patient roster.

Patients will be advised of any appointment details in the order of their addition to the wait-list. Please do not contact the office to inquire regarding the appointment. Only contact us if you wish for us to remove you from the list.

Please acknowledge that you have read and understood the above information. *

I understand the purpose of this sign-up form and I know I am not guaranteed to be registered with the clinic or any physician. I wish to add my name to the wait-list.

I do not wish to sign up for the wait list.

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