Register for a Family Doctor //

Please fill out the following form to register for a doctor at Halton Family Health Centre. You are able to use this form to register yourself, your spouse and your children, as well as select other medical services that Halton Family Health Centre provides. Someone will be in contact with you within 7 - 10 days.

Please Enter your Name the same way that it appears on your Health Card

First Name
Last Name
Address
Address 2
City
Region
PostaL Code
Country
Home Phone
Cell Phone
Email
Health Card Number
Health Card Version Code (The last two LETTERS on the card)
Date of Birth
Who would you like to register
Please Provide us with your Spouse and Children's Names as well as Health Card Number
What kind of Doctor would you prefer
No Preference
Male Physician
Female Physician
What Other Services Would You Like to Hear From
Wharton Medical Clinic - Weight & Diabetes Management
Naturopathic Doctors
Physiotherapy
Chiropractor
Dental
Optometry
Hearing Specialist‎‎
Name of Preferred Dr.