We continue to work to recruit new physicians to our team.

If you don’t currently have a doctor or nurse practitioner and live in our catchment area (described below) please put your name on our waiting list by filling in this form.

Our catchment area includes the Municipalities of Powassan and East Ferris, Townships of Chisholm and Nipissing, Laurier to the east and communities west of Powassan (which includes Restoule, Commanda, Arnstein, Golden Valley, Port Loring and Loring).

PLEASE NOTE:
  • Only those patients in our catchment area are eligible to put their names on this list.
  • Putting your name on this list does not guarantee that you will become a patient with one of our physicians.
  • This form uses Survey Monkey, which is not an encrypted secure platform. If you would rather, you can call the office to be added to the list. 705-724-1020.
We will contact you if, and when, an opening becomes available in our practice. Thank you!

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* 1. If you live outside of the catchment area but pay taxes to one of the townships in our catchment area, please enter the township you pay taxes to below

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* 2. Have you already added your name to our list?

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* 3. Contact Information

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* 4. Please enter your date of birth

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* 5. Total number of family members, including you, on this list (Please ADD EACH ONE SEPARATELY):

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* 6. Are you registered with Health Care Connect?

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* 7. Have you been a patient of any of our physicians in the past?

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* 8. Do you currently have a family physician?

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