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.

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 *

Please let us know which clinic you prefer, recognizing that it will not be an option to subsequently switch physicians / locations. -------------------------------------------------------------------------------- Different locations currently have different timelines for scheduling your first intake appointment, as follows: MIDTOWN: Appointments are readily available once your registration is processed (~5 business days). RIVERSIDE: Appointments are readily available once your registration is processed (~5 business days). THE BEACHES: Appointments will likely be available November onwards. --------------------------------------------------------------------------------

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

I prefer a doctor at the Beach (Queen & Woodbine) location. I acknowledge the likely timeline for booking my intake appointment.

I prefer a doctor at the Riverside (Queen & Broadview) location.

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

I have no preference between the Riverside (Queen & Broadview) and Midtown (Avenue & Eglinton) locations.

I have no preference between any of the locations.

Additional comments

Please note we do not triage / prioritize patients on the basis of medical need. To be equitable, we process patients on a first-come first-served basis only.

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