Document Upload

Please Upload Your Health Card

Important Notice Regarding Health Card Numbers: Your Ontario Health Card Number is collected for identification and charting purposes only and is used by our clinic as your unique chart number within our electronic medical record system.

Name

This field is for validation purposes and should be left unchanged.

Name(Required)

Email Address(Required)

Health Card Number(Required)

File(Required)

Drop files here or

Max. file size: 25 MB, Max. files: 2.