Albany Medical Clinic

Family doctors - Specialists - Speciality services, diagnostic services, walk-in clinic.

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(416)-461-9471

807 Broadview Ave, Toronto, Ontario M4K 2P8

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NEW PATIENT REGISTRATION FORM

Thank you for your interest in the Albany Medical Clinic!

Please complete the following form if you would like to be added to our Wait List. You can use the form to add family members as well.

A member of our team will contact you within 1 week to review your completed Form and advise you about the status.
First Name*
Last Name*
Date of Birth*
Sex*
Apt/Suite #
Address*
City*
Postal Code*
Contact #*
Contact Email*
Physician Preference*
- First Available
- Male
- Female
Do you wish to add other family members to the wait list?*
- Yes
- No
Family Members details:
Family Member details:
First Name*
Last Name*
Date of Birth*
Sex*
Apt/Suite #
Address*
City*
Postal Code*
Contact #*
Contact Email*
Physician Preference*
- First Available
- Male
- Female
Other Family Members you wish to add to the Wait List?*
- Yes
- No
Family Members details:
Family Member details:
First Name*
Last Name*
Date of Birth*
Sex*
Apt/Suite #
Address*
City*
Postal Code*
Contact #*
Contact Email*
Physician Preference*
- First Available
- Male
- Female
More family member you wish to add to wait list?*
- Yes
- No
Family Members details:
Family Member details:
First Name*
Last Name*
Date of Birth*
Sex*
Apt/Suite #
Address*
City*
Postal Code*
Contact #*
Contact Email*
Physician Preference*
- First Available
- Male
- Female
Tell us how you heard about our Online Patient Registration ?*
- Albany Medical Clinic Staff Member or Physician ?
- Friend or Family Member already at the Albany Medical Clinic ?
Please note: Submission of this Form does not automatically enrol you as a patient of the Albany Medical Clinic
By clicking ‘Accept’, I acknowledge that the Albany Medical Clinic may collect my information, contact me or provide me with information regarding the Albany Medical Clinic and its services.*
- I accept
- I do not accept
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Map of AMC Location

807 Broadview Ave, Toronto, Ontario.
Phone number: 416-461-9471.

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New Patient Registration

CLINIC DIRECTORY

CLICK HERE TO SEE THE DIRECTORY

ACCESSIBILITY

CLICK HERE for more information on how the Albany Medical Clinic is meeting AODA Accessibility Standards

Copyright © 2019 Albany Medical Clinic. All Rights Reserved.

807 Broadview Ave, Toronto, Ontario.
Phone number: 416-461-9471.