Request A Family Doctor

Our doctor's are committed to improving access to comprehensive family practice to residents of the community of Orleans. At various times different doctors accept patients - if you require a family doctor please complete this form to be added to the list of patients in need of a doctor. You will be contacted and provided a first appointment.

Request A Family Doctor

First Name:

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Initial:

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Last Name:

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Address:

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Primary Phone:

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Secondary Phone:

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Email:

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Confirm Email:

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Previous Doctor:

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Reason for seeking a new doctor:

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I prefer:

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I prefer:

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I speak an unofficial language:

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I am a human:

 


Many doctors in our group speak other languages and where possible we will accommodate patients. However otherwise the patient will be responsible to bring an interpreter to all visits.

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