Patient Info

New Patient Form

First Name

Last Name

Date of birth

Gender

Male

Female

Other

Address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Home Phone #

Cell Phone #

Work Phone #

Preferred Contact

Home

Cell

Work

Health Card Number (OHIP). (0000-000-000-XX)

If you have a refugee status, add the UCI number

Upload a copy of IFH paper

Choose File

If you don’t have any insurance, upload your passport copy

Choose File

Name of your preferred doctor

Emergency Contact Name:

Relationship to you:

Emergency Contact Phone #

Allergies:

Medications:

Consent

I have read and accepted Mi Clinic’s terms and conditions

Frequently Asked Questions (FAQs)

What to Bring for Appointments?

To help us provide you and your family with the best possible care, please come prepared with the following:

A valid health card / OHIP card
A complete list of all current medications
Any known family medical history

Do I need an appointment to see a doctor?

Appointments are recommended for guaranteed availability, but we also offer walk-in visits depending on physician
schedules.

Does Mi Clinic accept new family practice patients?

Yes, we welcome new patients. Availability may vary, so we encourage contacting us to register.

Can children be seen at the clinic?

Absolutely. Our doctors provide full pediatric care, including checkups, immunizations, and growth monitoring.

How long will my appointment take?

Appointment times vary depending on medical needs. Some visits may take longer to ensure thorough care, which can
occasionally lead to delays. We appreciate your understanding as we prioritize quality care for every patient.

Can I get my immunizations or flu shot here?

Yes. We provide routine vaccines and seasonal flu shots for individuals and families.

Is Mi Clinic wheelchair accessible?

Yes, our clinics are fully accessible to accommodate patients with mobility needs.