Patient Waiting List | 患者候诊名单

Join the patient waiting list

Fields marked * are required. Information is encrypted and available only to authorized clinic administrators.

Patient informationPlease enter your name in English exactly as shown on your BC Services Card.

Last name * Use English letters or numbers. Spaces, hyphens, apostrophes and periods are allowed; other languages are not accepted.First name * Use English letters or numbers. Spaces, hyphens, apostrophes and periods are allowed; other languages are not accepted.Date of birth * Personal Health Number (PHN) * Enter the 10-digit BC Personal Health Number.Cell Phone number * Email * Gender * Preferred language * Address * City * Province * Postal * Preferred provider * Do you have a family doctor? * Current medical conditions Current medications Past surgeries Medication allergies and reactions

For a medical emergency, call 9-1-1. Do not use this form for urgent medical advice.