New Patient Application Form

We are accepting applications for new patients! If you are interested in rostering with the Woolwich Community Health Centre, please fill out the form and one of our staff members will contact you. We will be working through new forms as soon as we can.  Thank you for your patience!

If you have any questions, feel free to email [email protected]

If you’d like to add more than one person, please fill out a form for each person.

 

Please note that we will be working through our existing list of people needing care. So, if you have already applied to be a patient then we will connect with you shortly.

New Patient Intake

Please fill out this form if you are interested in becoming a rostered patient at WCHC.

Name(Required)
Email(Required)
MM slash DD slash YYYY
Address(Required)