Registration Form - YC Medical

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PATIENT DETAILS

Date *

Patient First Name *

Patient Last Name *

Date of Birth *

Gender *

Email *

Cell Phone Number

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Reason For Appointment *

EMERGENCY CONTACT INFORMATION

Emergency Contact's Name *

First

Last

Contact Number *

Relation to Patient *

Language Preference *

English
French
Persian/Farsi

FINAL STEP

How Did You Hear About Us?

Internet/Search Engine
Friend Referal
Social Media
Referral
TV/Radio
Third-Party Review
Other

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Call Now: 647-547-8184

YC Medical Center

Yonge Cummer Medical Centre is dedicated to providing the best possible care for our patients. We strive for a higher standard of excellence through the provision of expanded services that allow our patients to manage their health and improve their quality of life.

REGISTRATION FORM

Services

Medical
Pharmacy
Nutrition
Naturopathic Medicine
Skin Care

Hours of Operation

Monday: 9 AM – 7 PM
Tuesday: 9AM – 7 PM
Wednesday: 9AM – 7 PM
Thursday: 9AM – 7 PM
Friday: 9 AM – 7 PM
Saturday: 10 AM – 3 PM
Sunday: CLOSED

Contact

5925 Yonge St. North York, ON M2M 3V7
647-547-8184
416-222-2394 (Clinic Fax)
647-547-8186 (Pharmacy Fax)
pharmacy@ycmedicalcentre.ca
clinic@ycmedicalcentre.ca

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We offer Walk-In services • Please Click Here and Fill up the Registeration Form.

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Registeration Form

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