New Patient Registration Form

Become a patient at Hunter Medical Centre in just a few clicks.

Fill out some quick info below in our secure form to register as a new patient and a team member will be in touch shortly to confirm!

First Name

Last Name

Date of Birth

Gender

Health Card # & Version Code

Phone

Address

City

Province

Postal Code

Marital Status

Occupation

Current Family Doctor (If Applicable)

Preferred Pharmacy (If Applicable)

Smoking?

Alcohol?

Past Medical History

Past Surgical History

Current Medications

Social & Family History

List any medications you take for chronic pain

List any sleeping medications you take