Registration Form

Registration Form for Family Physician
If you would like to register for family practice at Medicare, please hit submit and it will redirect you to the appropriate form to fill out.

Thank you,
Medicare Pharmacy & Medical Center
First Name
Last Name
Sex
Address
City
Province
Postal
Phone #
Email
DOB

YearMonthDay
Health Card/OHIP Number
Version Code (Two letters after OHIP #)
Should be Empty:

Registration Form for Family Physician