Patient intake

Become a patient at Cedar Health

Please complete this form to register. It takes about 10 minutes, and your information is kept private and secure. Fields marked * are required.

⚠️ This form is not for emergencies or urgent medical problems. If you have a medical emergency, call 911.

Patient information
Health card

If you have an Ontario health card, adding it now speeds up your first visit. You can leave this blank and bring it with you instead.

Contact information
Emergency contact
Your care today
Medical history
Do you have, or have you had, any of these? (tick all that apply)
Medications & allergies
Family history
Conditions that run in your family (tick all that apply)
Lifestyle
Privacy & consent
Privacy notice

Cedar Health collects the personal health information on this form to register you as a patient and to provide and coordinate your care. Your information is stored securely and is accessible only to Cedar Health staff involved in your care. We do not sell your information or use it for advertising. You may ask to see or correct your information, or ask questions about our privacy practices, by contacting the clinic. This collection is carried out under Ontario's Personal Health Information Protection Act (PHIPA).

By submitting, you confirm you have read the privacy notice above.