Instructions

If you'd like to register or transfer to a Magenta Health physician, please complete the following form. We'll use the information submitted to validate your OHIP. Once this is done, we will be in touch with you by email to schedule a new patient intake appointment with a particular doctor.

For patients interested in seeing a physician out of our new Midtown location, appointments are available quickly.

For patients interested in seeing a physician out of our original Riverside location, many of our physicians are close to capacity and so only a limited number of new patient intake appointments are available each month. This is to ensure that existing patients continue to have timely access to medical care. It may unfortunately take a few months before you're able to book a convenient intake appointment.

Kindly note that it is not an option to switch locations / physicians after you have had your new patient intake appointment.

For families and couples, kindly complete this form multiple times, once for each individual. Additionally, kindly note that our clinic policy is that we do not accept infants or children under 5 years of age unless at least one parent or guardian is enrolled as a patient at Magenta Health.

Although the purpose of this process is for you to become a patient of one of the family physicians at Magenta Health (which will involve transferring your medical care from your current family physician to your new family physician, if applicable), please note that completing the following form alone does not make you our patient.

What is your 10 digit health number? *

e.g. 0123456789, 3821694372 (see below for more information)

If applicable, what is your 1 or 2 character version code?

e.g. TA or N, or simply leave blank (see below for more information)

First Name *

Last Name *

Street Address (including unit number, if applicable) *

City *

Province *

Postal Code *

e.g. A1A 1A1

Email Address *

Primary Personal Phone Number *

Primary Personal Phone Number

(E.g. home phone)

(###)

###

####

Work Phone Number

(###)

###

####

Secondary Personal Phone Number

(E.g. cell phone)

(###)

###

####

Preferred Clinic Location *

Our original clinic in Riverside is close to capacity. Our new Midtown location opened recently and is accepting new patients. Our long-delayed clinic in the Beach is scheduled to open in 2018. Please let us know which clinic you prefer, recognizing that it will not be an option to subsequently switch physicians / locations.

I prefer a doctor at the Midtown (Avenue & Eglinton) location.

I prefer a doctor who will be moving to the Beach (Queen & Woodbine) location. I understand that appointments will take place in the meantime at Riverside (Queen & Broadview).

I prefer a doctor who will be staying in Riverside (Queen & Broadview). I understand that it will take a few months before I am able to book an intake appointment.

I have no preference between the Riverside (Queen & Broadview) and Beach (Queen & Woodbine) locations.

Additional comments

How did you hear about us? *

I agree to Magenta Health Inc. contacting me by email *

Yes

HEALTH NUMBER AND VERSION CODE

The following images explain what your health number and version code are, for different health card versions. It is important that this information be provided to us correctly so that we may properly validate your OHIP.

Source: Health Card Validation Reference Manual - Ontario