PEI Provincial Patient Registry Application Form

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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
For example C1B 0X1 or 12345
For example 902-555-5555
For example: 902-555-5555
For example: 902-555-5555