TOR 2 - NOT MY FAMILY DOCTOR FORM

Please enable JavaScript in your browser to complete this form.

(staff) Date Witness

Date *

I understand that Dr. Taylor is not my family doctor.

I understand that Dr. Taylor only provides medical treatment for my opioid dependency.

I understand that I need to obtain a family doctor for preventative medicine.

I have read and understand the document that I have signed.

Patient Name *

Patient (Signature) *

Clear Signature

Witness Signature (staff)

Clear Signature

Quick Links

Designed & Developed by

Existing Patient (OHIP)