ENROLMENT FORMS FOR SOMC PATIENTS

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*** THIS ONLY APPLIES TO PATIENTS ALREADY REGISTERED WITH AN SOMC PHYSICIAN ***

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1) Click on PDF icon below to download the enrolment forms.

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2) Fill out forms electronically or manually and SIGN PAGE 1 + 2:

a. Patient Enrolment and Consent to Release Personal Health Information (on page 1)

b. Patient Health Care New Patient Declaration form (on page 2)

 

3) Return signed forms via following options:​​​​​

a. DROP OFF 

• You may drop off the forms at the South Ottawa Medical Centre during our hours of operation.

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b. MAIL 

• You can send the forms back to our office by mail. 

• Our mailing address is: 

South Ottawa Medical Centre
2-1650 Queensdale Avenue, Gloucester, ON K1T 1N8

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Note: 

Any forms completed by individuals who are not currently registered patients at SOMC will be discarded.