Print Patient Forms

1. Download Form (PDF, 44KB)

The Patient Form is in PDF format and requires Adobe Acrobat Reader 4.0 or greater to open it. If you do not already have the latest version on Adobe Acrobat Reader, download it free.

2. Complete Form

Use the checklist found on page 1 to complete the Patient Forms.

3. Mail or Fax

Once the form is completed mail or fax to: 1-800-728-0244

Mailing Address:
Box 11 Group 100 RR2
Lorette, MB R0A 0Y0
CANADA

TIP: Regular mail takes approximately 2 weeks for your forms to arrive at our door while AIR MAIL takes only 5 days!