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. Please note that our team will process your application as soon as we can. We will be prioritizing patients based on need and other factors. We assure you, we will get to your application as soon as possible. Please do not apply more than once, or call the office to inquire about the status of your application. If you have any questions, please email [email protected]

Name(Required)
Email(Required)

Date of Birth

Address(Required)
Provider Assignment Acknowledgement
Our clinic is staffed by both Family Physicians and Primary Care Nurse Practitioners who work collaboratively to provide comprehensive primary care to patients across the lifespan. In Ontario, Nurse Practitioners are highly trained, autonomous health-care providers who assess, diagnose, order and interpret tests, prescribe medications, manage chronic and acute illnesses, and provide ongoing primary care services within their scope of practice—similar to Family Physicians in a primary care setting. To support equitable access to care and maintain timely patient attachment, new patients are assigned to either a Family Physician or a Nurse Practitioner based on clinic availability. Provider assignments are made randomly and requests for a specific provider type will not be accommodated. Do you agree to be assigned to either a Family Physician or a Nurse Practitioner?