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Dr. Jay Geddes New Patient 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 rostering@tworiversfht.ca or mail, at

Attention: Rostering

HealthLink Family Practice 

B10-350 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.

Lastly, if you have not yet had an appointment with me I would like you to please CLICK ON THIS LINK and then click on "New Patient" to complete the secure, online new patient form to help me prepare for our first visit.

Thank you.

Dr. Jay Geddes

Attachment (click to download):
 Adobe Acrobat Document Dr Jay Geddes Enrolment Form.pdf