Mon–Thu 8–6 · Fri 8–5 · Sat 9–2
905-773-7759 |
Patient Intake

Become a Patient at
Oak Ridges Medical

Complete your patient intake form below to help our team understand your health needs before your visit. It only takes a few minutes.

What to Expect

A few things to have ready

To complete this form, please have the following on hand:

Your Health Card

Ontario Health Card number and version code

Your Medical History

Current medications, known allergies, and any recent diagnoses

An Emergency Contact

Name, relationship, and phone number

All fields marked with an asterisk (*) are required. Your information is kept strictly confidential. Have questions? See our FAQ.

Registration

Patient Intake Form

Please fill out the following form to help us understand your physical condition.

Patient Information


Emergency Contact

Please provide up to two emergency contacts.

Primary Contact

Secondary Contact


Health History & Concern

symptoms, diagnosis, duration, onset

Are you currently suffering from a medical condition, illness, or injury? *
Have you been hospitalized in the last 12 months? *

Declaration

Your Privacy Is Protected

The information you provide in this form is used solely to support your care at Oak Ridges Medical and Urgent Care Centre. All patient data is handled in accordance with Ontario's Personal Health Information Protection Act (PHIPA).

Questions about your privacy? View our Policies

Questions?

We're here to help

If you have trouble completing this form or prefer to register in person, our admin team is happy to assist you.

  • Call Us

    905-773-7759
  • Fax

    905-773-1325
  • Address

    13291 Yonge Street, Suite 100,
    Richmond Hill ON L4E 4L6
Meet Our Admin Team

Clinic Hours

  • Mon – Thurs 8am – 6pm
  • Friday 8am – 5pm
  • Saturday 9am – 2pm
  • Sunday Closed

Your Health Starts Here

Ready to see us?

Walk in or book ahead — our team is ready to care for you and your family.