New patient waitlist

Join our waitlist.

Our practice is full right now. Leave your details below and we'll contact you when a place opens. It takes about two minutes.

Patient details

One form per patient, including children. For a child, enter the child's details and a parent or guardian's email and phone number.

Please don't include any health information. We only need identification and contact details to hold a place on the list.

Patient

First name *

Last name *

Date of birth *

Health card (OHIP) number *

Address

Street address *

City *

Postal code *

Contact

Email *

Cell phone *

Is an immediate family member already a patient at Divine Medical Centre? *

Yes No

This patient's previous family doctor retired or closed their practice.

Joining our list doesn't guarantee a place. We recommend you also register with Health Care Connect, Ontario's free matching service.

Health Care Connect Or call 811