ENROLMENT FORMS FOR SOMC PATIENTS
*** THIS ONLY APPLIES TO PATIENTS ALREADY REGISTERED WITH AN SOMC PHYSICIAN ***
1) Click on PDF icon below to download the enrolment forms.
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
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You may drop off the forms at the South Ottawa Medical Centre during our hours of operation.
b. MAIL
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You can send the forms back to our office by mail.
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Our mailing address is:
South Ottawa Medical Centre
2-1650 Queensdale Avenue, Gloucester, ON K1T 1N8
Note:
Any forms completed by individuals who are not currently registered patients at SOMC will be discarded.