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Dr. Meghan King Rostering Form

For your convenience and reference we summarized the steps of completing the forms included below: 

Page 1: Patient Enrolment and Consent to Release Personal Health Information:

Page 2: Primary Health Care New Patient Declaration:

Page 3: Patient Enrolment and Consent to Release Personal Health Information

Please return the completed form (pages 1 AND 2) to our office by e-mail at forms@tworiversfht.ca or mail, at

Attention: Rostering

Hespeler Medical Clinic 

B12-350 Conestoga Blvd.

Cambridge, ON  N1R 7L7

If you are scanning the document and sending via e-mail we do not require the original form provided that the scan is clear and your signature is legible.

Thank you.

Yours truly,

Dr. Meghan King

Attachment (click to download):
 Adobe Acrobat Document Dr. M. King Rostering Form.pdf