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Parent/Guardian
Account Registration
Address*
Apartment, unit, etc.
City*
Province*
Postal Code*
Preferred Clinic Location*
Orleans
Kanata
Privacy Policy
I authorize the clinic and its associated health professionals to collect my personal and medical information as documented above. In addition, I authorize the clinic and its associated health professionals to communicate with my family doctor and/or referring doctor as deemed necessary for my beneficial treatment. I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission.
Do you acknowledge and agree to our Privacy Policy?
Yes, I agree
Extended Coverage
OAP
Yes, I agree
Would you like us to contact you for Occupational Therapy, Physiotherapy or Social Work?
Yes, please contact me
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