Current Page 1 Page 2 Preview Personal information is collected under the authority of Section 31(c) of the Freedom of Information and Protection of Privacy Act and will be used for the purposes of assisting you to obtain a family doctor. Questions on the collection and use of this information can be directed to the Patient Registry. Identification First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Virtual Care will require a valid e-mail address. Work Phone For example: 902-555-5555 Cell Phone For example: 902-555-5555 Date of Birth Gender - Select -MaleFemale