Patient Registration

Fairway Medical

Welcome to Fairway Medical Clinic! Please complete this form. Your information is protected under PHIPA (Ontario).

First Name

Last Name

Date of Birth

Gender

Health ID Number

Version Code

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Email

Phone

Reason for Booking

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Providing compassionate, comprehensive healthcare to our community since 2009. Your health is our highest priority.