The purpose of this questionnaire is to ensure that your medical
record contains complete information to enhance optimal care.
Please fill in the relevant sections to the best of your ability
and return to the clinic upon completion before your meet &
greet appointment. Information provided are kept confidential.
Priority will be given to patients without a local Family
physicians or patients of retired Family physicians.
Priority will be given to patients without a local Family
physicians or patients of retired Family physicians.